Perinatal Outcomes Research Articles

Maternal and fetal outcome of postdated pregnancy; A cross sectional study

Background: Postdated pregnancy refers to a pregnancy that extends beyond the expected date of delivery, which is 280 days. When a pregnancy surpasses 42 weeks (more than 294 days), it is termed as post-term pregnancy. Postdated pregnancy is one of the most common obstetric problems associated with increased maternal and foetal morbidity, and mortality. Gestational age is among the most important determinants of perinatal outcomes, but studies have focused more on preterm births (<37 completed gestational weeks) and less on the understanding and prevention of post term births. Objectives: To assess the maternal and fetal outcome of postdated pregnancy. Material and Methods: Present observational descriptive cross sectional study was conducted for the period of 1 year from 1st April 2023 to 31st March 2024. Total 150 postdated pregnant women included in present study as per predefined after satisfying the inclusion and exclusion criteria. Results: During study period out of total deliveries 110 were postdated deliveries. Out of them 46.36% and 28.18% were of 21-25 years and 26-30 years of age respectively. The mean age of all participants was 25.51 ± 4.58 years. A statistically significant association was found between the gestational age of postdated women and their mode of delivery. Out of 110 postdated women, 68.18% and 31.81% had vaginal and caesarean deliveries, respectively. Conclusion: Adverse maternal and fetal outcomes of post-dated pregnancy should be anticipated and counseling of women at risk of post-term pregnancy and timely management for its prevention is recommended

Early experience of fetal laser photocoagulation for twin-to-twin transfusion syndrome in the Philippines

Objectives: This study aims to review the outcomes of monochorionic pregnancies with Twin-to-Twin Transfusion Syndrome (TTTS) treated with fetal laser photocoagulation (FLP) in the Philippines and to compare these with outcomes from the early experiences of other nearby centers in Southeast and East Asia. Methods: This is a single center retrospective cohort study of 7 patients who underwent FLP for TTTS before 26 weeks of gestation from June 2021 to March 2024. Preoperative, perioperative, perinatal, and neonatal outcomes were analyzed and a comparison with other Asian centers was performed. Results: Patients treated were in advanced stages III-IV of TTTS (86%). Gestational age at FLP was 22.1 ± 2.8 weeks. The perinatal overall survival rate was 64% with a double survivor rate of 57%, a single survivor rate of 14%, and at least one survivor in 71%. The interval between FLP and delivery was 36.6 ± 25.2 days with age at delivery of 27.1 ± 4.3 weeks. Compared to 5 other Asian centers, procedures performed per year ranged from 2.5 to 14.2 cases. Overall fetal survival rates were between 64 to 82%. Conclusion: Our center’s early experience of treating TTTS with FLP reflects the current conditions of prenatal screening and access to specialized care in the country. Early recognition of TTTS is key to providing patients and their families timely management and support. Devising local standardized assessments for education and performance of FLP, establishing the surgical learning curve, facilitating audits, and initiating research will improve fetal surgery benchmarks in the country.

Outcomes of pregnancies with varying levels of nuchal translucency measurements: A population-based retrospective study in Ontario, Canada.

Nuchal translucency prenatal ultrasound is widely used to screen for chromosomal abnormalities. An elevated nuchal translucency has been associated with adverse outcomes such as pregnancy loss; however, extant studies investigating these associations have had important limitations, including selection bias. This study aimed to investigate the association between nuchal translucency measurements and pregnancy outcome, specifically, a composite of pregnancy loss, termination, stillbirth, or neonatal death. This was a population-based retrospective cohort study conducted with data from the prescribed perinatal registry in Ontario, Canada, Better Outcomes Registry & Network. All singleton pregnancies with an estimated date of delivery from September 1, 2016, to March 31, 2021, and multiple marker screening including a nuchal translucency were included. Pregnancies with measurements 2.0- < 2.5 mm, 2.5- < 3.0 mm, 3.0- < 3.5 mm, 3.5- < 5.0 mm, 5.0- < 6.5 mm, and ≥6.5 mm were compared to a reference group with measurements <2.0 mm. We used multivariable modified Poisson regression models with robust variance estimation to estimate associations between nuchal translucency measurement and pregnancy outcome, with adjustment for age at estimated date of delivery and gestational age at screening. There were 414 268 singleton pregnancies included in the study. The risk of pregnancy loss, termination, stillbirth, or neonatal death increased with increasing levels of nuchal translucency measurements, with an adjusted risk ratio (aRR) of 11.9 (95% confidence interval (CI) 9.9, 14.3) in the group with measurements 3.5- < 5.0 mm. When pregnancies with diagnosed chromosomal abnormalities were excluded, this association remained strong, with an aRR of 6.4 (95% CI 4.8, 8.5). Among pregnancies with a live birth, those with a higher nuchal translucency measurement (>5.0 mm vs. <2.0 mm) were also at increased risk of adverse perinatal outcomes such as admission to the neonatal intensive care unit and APGAR score <7. In this population-based study using robust methods to reduce the risk of selection bias, we found that pregnancies with increased nuchal translucency measurements are less likely to result in a live birth, even with the exclusion of chromosomal abnormalities. Pregnancies with increased nuchal translucency measurements that resulted in a live birth may also be at increased risk of adverse perinatal outcomes.

Long-Term Neurodevelopmental, Mental, and Cardiometabolic Health in Individuals Conceived with Assisted Reproductive Technology: A Literature Review

Background: Assisted reproductive technology (ART) has revolutionised fertility treatments since 1978 and, while itsimmediate perinatal outcomes have been extensively studied, its long-term health effects require exploration. Method: PubMed database was searched for studies spanning 2016 to 2023 to conduct this literature review of the long-term neurodevelopmental, mental, and cardiometabolic health of ART-conceived individuals. Results: A total of 49 studies were included in this review. ART-conceived individuals revealed mostly positive neurodevelopmental and mental health impacts. However, children conceived via intracytoplasmic sperm injection (ICSI)demonstrated an increased risk of neurodevelopmental disorders, including autism spectrum disorder, intellectual disability, and psychological and neurological development delays, while frozen embryo transfer was linked to an increased risk of language delay. Additionally, children born via ART as multiples or prematurely showed an elevated risk of cerebral palsy. While ART generally demonstrated a favourable impact on cardiometabolic health, there were concerns about increased risk of high blood pressure, altered lipid profiles, obesity, insulin resistance, premature vascular aging, and adverse metabolic changes. Specifically, ICSI-conceived individuals were more prone to adiposity and insulin resistance, while frozen embryo transfer was associated with type 1 diabetes. Conclusion: While ART-conceived individuals generally exhibit favourable health, specific subgroups may face elevated risks for certain neurodevelopmental disorders and long-term cardiometabolic issues, warranting further research. ART may be associated with metabolic alterations at a young age, potentially increasing the risk of chronic diseases such as metabolic syndrome, type 2 diabetes, and cardiovascular disease later in life. Continued long-term monitoring and targeted interventions are recommended to mitigate these risks.

First and second trimester laboratory changes and perinatal outcomes in pregnant women with epilepsy

Aims: The aim of this study is to comprehensively evaluate the demographic, first-second trimester laboratory parameters and perinatal outcomes in pregnant women with epilepsy. Methods: The study had a total of 73 pregnant women with epilepsy, along with 149 healthy pregnant women. Demographic data, first-second trimester laboratory parameters, seizures during pregnancy, the administration of antiepileptic medicines and perinatal outcomes were documented from September 2022 to 2023. Pregnant women with epilepsy were formed into subgroups according to whether they had seizures during pregnancy or not and whether they used antiepileptic drugs, and first- and second-trimester laboratory parameters were compared between the groups. Furthermore, univariate and multivariate linear regression analysis investigated the relationship between these parameters with the composite adverse neonatal outcomes (CANO). Results: In the study, 72.7% of pregnant women diagnosed with epilepsy were receiving antiepileptic treatment (75.4% monotherapy and 24.6% polytherapy). The incidence of seizures during pregnancy was 38.3%. The epilepsy group exhibited statistically significant differences from the control group in the following areas: gestational age at delivery, preterm birth rate, cesarean section rate, birth weight, neonatal head circumference, APGAR score

Prediction of adverse maternal and perinatal outcomes associated with pre-eclampsia and hypertensive disorders of pregnancy: a systematic review and meta-analysis

Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. If women at high risk for developing complications could be identified early, level of care could be triaged, limited resources could be correctly allocated and targeted interventions to prevent complications could be implemented. We updated a systematic review and meta-analysis and added single outcomes. Women with hypertensive disorders of pregnancy were included. Exposures were tests predicting adverse maternal and/or perinatal outcomes. We searched Medline, Embase, CINAHL, and Cochrane library from January 2016-February 2024. We included studies identified from the previous review. We calculated effect measures. For similar predictive tests and outcomes, area under the receiver-operating-characteristic curve (AUROC) were pooled. This study was registered by PROSPERO: CRD42022336368. Of the 2898 studies identified, 80 were included. Thirty were added from the previous review resulting in 110 included studies with 506,178 women. Despite more than 1500 tests being performed, most outcomes could not be pooled due to heterogeneity in populations, tests, and outcome definitions. For maternal outcomes, only studies reporting on the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) model could be pooled. For the composite outcome within 48-h the AUROC was 0.78 (95% CI 0.71-0.86, N=8). There was significant heterogeneity (I 2 =95.7%). For perinatal outcomes, data were pooled for pulsatility index in the umbilical artery and soluble FMS-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio. Biomarkers like the sFlt-1/PlGF ratio showed promising predictive performance for some outcomes but were not externally validated. Despite including over 100 studies with more than 1500 predictors, we were unable to pool any single maternal outcomes and only a few individual perinatal outcomes. The fullPIERS model was externally validated, showing moderate accuracy which varied across studies and should be validated in each new population. Angiogenic biomarkers showed promise but need validation. Future studies should use standardized outcome measures and validate promising tests. VB is supported by the Swedish Research Council, Grant number 2020-01481. University of Gothenburg.

Significant kidney disease in pregnancy: Feasibility and outcomes of a national population-based study using the Australasian Maternity Outcomes Surveillance System.

Current understanding of clinical practice and care for maternal kidney disease in pregnancy in Australia is hampered by limitations in available renal-specific datasets. To capture the epidemiology, management, and outcomes of women with significant kidney disease in pregnancy and demonstrate feasibility of a national cohort study approach. An Australian prospective study (2017-2018) using a new kidney disease-specific survey within the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with acute kidney injury (AKI), advanced chronic kidney disease (CKD), dialysis dependence or a kidney transplant were included. Demographic data, renal and obstetric management, and perinatal outcomes were collected. Among 58 case notifications from 12 hospitals in five states, we included 23 cases with kidney transplant (n = 12), pre-existing CKD (n = 8), newly diagnosed CKD (n = 2) and dialysis (n = 1). No cases of AKI were reported. Reporting rates were better in states with study investigators and, overall, cases were likely under-reported. Nearly 35% of women had a non-delivery-related antenatal admission. Nephrology involvement was 78.3% during pregnancy and 91% post-partum. Adverse events were increased, including pre-eclampsia (21.7%), and preterm birth (60.9%). Women had high rates of aspirin (82.6%) and antihypertensive (73.9%) use, indwelling catheter for labour/delivery (65.2%), caesarean delivery (60.9%), and blood transfusion (21.7%). This first-ever Australian prospective study of significant kidney diseases in pregnancy provided novel insights into renal-specific clinical patterns and practices. However, under-reporting was likely. Future studies need to overcome the challenges of case identification and data collection burden.

The Influence of Gentrification on Adverse Birth Outcomes in California.

Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed theassociations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds ofsmall-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.

Maternal and Perinatal Outcomes in Pregnancy with Leukemia: A Tertiary Institution Experience of 12 Pregnancies for 5 Years

Maternal and Perinatal Outcomes in Pregnancy with Leukemia: A Tertiary Institution Experience of 12 Pregnancies for 5 Years

Longitudinal evaluation of iron status during pregnancy: a prospective cohort study in a high-resource setting

BackgroundIron deficiency affects a large proportion of pregnant women worldwide, with potentially serious consequences for perinatal and infant outcomes, but well-powered, comprehensive analyses of longitudinal iron status during pregnancy are scarce. ObjectivesThis study aimed to evaluate the longitudinal changes in iron biomarkers across pregnancy and prevalence of iron deficiency in primiparous women in a high-resource setting and propose early pregnancy iron status cutoffs that predict iron deficiency in the third trimester. MethodsIn a prospective cohort of primiparous women with low-risk, singleton pregnancies in Ireland, iron [ferritin, soluble transferrin receptors (sTfR), total body iron (TBI)] and inflammatory markers (C-reactive protein, α-glycoprotein) were measured at 3 study visits: 15, 20, and 33 wk of gestation. Women with anemia (hemoglobin < 110g/L) at their first routine antenatal visit were excluded from this analysis. ResultsParticipants (N = 629) were Caucasian (98.2%) and born in Ireland (80.6%). The prevalence of iron deficiency (ferritin < 15 μg/L) increased throughout pregnancy, at 4.5%, 13.7% and 51.2% at 15, 20, and 33 wk of gestation, respectively. Using a ferritin threshold of <30 μg/L, rates of deficiency were 20.7%, 43.7%, and 83.8% across these time points, respectively. Application of sTfR of >4.4 mg/L generated similar prevalence data as ferritin of <15 μg/L at 7.2%, 12.6%, and 60.9%, respectively. Using TBI of <0 mg/kg, deficiency rates were lower than using ferritin or sTfR (P < 0.001). Using a cutpoint analysis method (area under the curve = 0.750), ferritin of <60 μg/L emerged as the ferritin threshold at 15 wk that predicted the presence of iron deficiency (ferritin < 15 μg/L) at 33 wk. Iron-containing supplements (mainly multivitamins) taken prepreganancy/early pregnancy was associated with reduced risk of deficiency throughout pregnancy, including the third trimester (odds ratio: 0.57; 95% confidence interval: 0.39, 0.82; P = 0.002). ConclusionsPregnancy places a remarkable strain on maternal iron status even in a high-resource, generally iron-supplemented population. Women should be screened early in pregnancy for iron status, with a suggested target ferritin concentration of >60 μg/L.This trial was registered at clinicaltrials.gov as NCT01891240 (IMPROvED Study; ==https://www.clinicaltrials.gov/study/NCT01891240?cond=NCT01891240&rank=1).

Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study.

Children born after assisted reproductive technology (ART) have worse perinatal outcomes compared with spontaneously conceived children. This study investigates whether children conceived after ART have a higher risk of congenital heart defects (CHDs) compared with children born after spontaneous conception (SC). All 7 747 637 liveborn children in Denmark (1994-2014), Finland (1990-2014), Norway (1984-2015), and Sweden (1987-2015), where 171 735 children were conceived after ART, were included. National ART and medical birth registry data were cross-linked with data from other health and population registries. Outcomes were major CHDs, severe CHDs, 6 hierarchical CHD lesion groups, and 10 selected major CHDs, diagnosed prenatally or up to 1 year of age (Denmark, Finland, and Sweden) and prenatally or at birth (Norway). The association between ART and CHDs was assessed with multivariable logistic regression analysis, with adjustment for available confounders. Major CHDs were detected in 3159 children born after ART (1.84%) and in 86 824 children born after SC [1.15%; adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 1.31-1.41]. Risk was highest in multiples, regardless of conception method. Severe CHDs were detected in 594 children born after ART (0.35%) and in 19 375 children born after SC (0.26%; AOR 1.30; 95% CI 1.20-1.42). Risk was similar between ICSI and IVF and between frozen and fresh embryo transfer. Assisted reproductive technology-conceived children have a higher prevalence of major CHDs, being rare, but severe conditions. The absolute risks are, however, modest and partly associated with multiple pregnancies, more prevalent in ART.

Asthma and pregnancy: Understanding the dynamic relationship - A comprehensive review

The health of pregnant women and their developing fetuses can be greatly impacted by asthma, a prevalent chronic respiratory disease. Pregnancy-related asthma is a serious health risk. A potentially fatal condition that makes many pregnancies more difficult is asthma. The prevalence of asthma has increased within the past few decades. This comprehensive review explored the complex connection between asthma and pregnancy. Analyzing physiological alterations during pregnancy revealed dynamic interactions between immunological responses and respiratory function. These Important discoveries highlight the susceptibility to exacerbations of asthma. This discussion focuses on the links between poorly managed asthma and unfavourable - perinatal outcomes, with particular attention given to maternal and fetal outcomes, tracking and tailored treatment to provide the best possible management of asthma. This review emphasizes how important it is to manage asthma throughout pregnancy because it can have a positive impact on both the mothers and fetuses long-term health. Consequences for clinical practice emphasize the value of preconception care, ongoing surveillance, and joint obstetrician-pulmonologist efforts. This review also sheds light on how common asthma is in expectant mothers, and this field's future directions require further investigation. Low birth weights and small for gestational age are associated with a greater risk, especially in women who have moderate-to-severe asthma and have episodes of the condition during pregnancy. Additionally, there was a slight but statistically significant increase in the chance of congenital deformities. By preventing exacerbations, active management may lessen these risks. Ensuring optimal management of asthma during pregnancy is crucial for the welfare of the expectant mother and the unborn child. While poorly managed and undertreated asthma is linked to a number of dangers for both mothers and fetuses, well-controlled asthma reduces the risk of complications for both mothers and fetuses.

The role of immune factors in the development of preterm birth

Preterm birth (PB) carries a high risk of developing neuropsychological development disorders, cognitive and somatic problems in the child. The maternal immune system plays a critical role in maintaining a physiological pregnancy. However, specific mechanisms and disorders of pregnancy development have been little studied. There is a lack of research on the role of immune competent cell (ICC) activation in preterm labor leading to uterine contractility. Understanding the importance of immune system factors in the formation of preterm birth may allow the development of strategies to prolong pregnancy and, thus, lead to improved perinatal outcomes. The purpose of the work is to study the role of immune factors in the development of preterm birth. Seventy pregnant women in the third trimester with recurrent miscarriage (RPL) and 25 healthy pregnant women (control group) were examined. Observed pregnant women with RPL were divided into two groups: Group I – patients who gave birth prematurely (n = 30); and Group II – patients who gave birth at term (n = 40). The population and subpopulation composition of peripheral blood lymphocytes was studied by cytofluorimetry using monoclonal antibodies to: CD3, CD4, CD8, CD16, CD19 (JSC "Sorbent", Russia) (FITC), CD11b (Beckman Coulter, USA); CD14, CD25, CD69, CD71, CD28, CD107a, HLA-DR (Beckman Coulter, USA) (PE). To create a database and conduct statistical research, the capabilities of an Excel spreadsheet and application packages (Megastat and Statistica 6.0) were used. When determining statistical significance between the study groups, the Mann-Whitney test was used for independent groups and the Wilcoxon test for dependent groups. Modulation of the number and functional activity of ICC in patients with RPL had a significant correlation with pregnancy outcome. Inadequate activation of the immune system is a factor that can lead to miscarriage. Termination of pregnancy before term is associated with subpopulation shifts, increased activation potencies of immunocompetent cells compared to full-term birth, which is an important feature of the inflammatory response. The identified immune changes will allow the development of early prevention methods and new approaches to the treatment of this pregnancy complication.

Fluid resuscitation strategy in patients with placenta previa accreta: a retrospective study.

Obstetric hemorrhage is the leading cause of maternal death worldwide. Placenta previa accreta is one of the major direct causes of postpartum hemorrhage, accounting for two-thirds of obstetric hemorrhage cases. Fluid resuscitation is a life-saving procedure for patients suffering from massive hemorrhage. This study aims at evaluating the risk factors of massive hemorrhage and appropriate fluid resuscitation strategy in patients with placenta previa accreta. This study retrospectively analyzed the risk factors for massive hemorrhage, clinical characteristics, and perinatal outcomes of patients with placenta previa accreta. Maternal noninvasively evaluated hemodynamic indicators, including maternal heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and shock index, were collected and analyzed at nine time points, from the administration of anesthesia until the end of procedures, in patients diagnosed with placenta previa accreta and receiving different fluid supply volumes. Complicated with placenta increta/percreta and gestational age of delivery later than 37 weeks are two independent risk factors of massive hemorrhage in patients with placenta previa accreta. A total of 62.27% (170/273) patients diagnosed with placenta increta/percreta had massive hemorrhage, significantly higher than those diagnosed with placenta previa accreta (5.88%, 6/102). Patients delivered after 37 weeks of gestation had significantly higher ratios (86.84%, 99/114) of massive hemorrhage compared with those delivered between 36 and 36+6 weeks of gestation (35.39%, 63/178). Maternal SBP, DBP, and MAP started to decrease immediately after the baby was delivered and reached a relatively stable trough state at 15-30 min after delivery. No statistical differences were found in hemodynamic indicators, the occurrence of hypotension, or in-hospital days after the procedure among the transfusion volumes < 30 ml/kg, 30-80 ml/kg, and ≥ 80 ml/kg groups. Patients with a suspected diagnosis of placenta previa accreta should plan to deliver before 37 weeks of gestation. The ability to identify concurrent placenta increta/percreta should be improved to schedule a reasonably rapid perioperative plan. Restrictive fluid resuscitation could achieve good effects in maintaining hemodynamic stability in patients with placenta previa accreta. A time period of 15-30 min after delivery is the critical stage for fluid resuscitation.

Effects of nationwide adjustment of tocolysis protocol in the Netherlands on neonatal outcomes in women with threatened preterm birth and delivery at 30-32 weeks of gestation: A cohort study

ObjectiveIn 2019 the Dutch national prevention of preterm birth (PTB) protocol was adjusted to withhold tocolysis for threatened PTB above 30 weeks of gestation due to insufficient evidence regarding its effectiveness on improving perinatal outcomes. The aim of this study is to evaluate neonatal outcomes of children born in the Netherlands between 30 and 32 weeks of gestation before and after the national protocol change. Study designWe performed a nationwide retrospective cohort study comparing outcomes of births in the years 2018 (tocolysis) and 2020 (no tocolysis). Tocolytic therapy consisted of either nifedipine or atosiban. Data were extracted from the national Perinatal Registry (PERINED). Women with a spontaneous PTB from 30 + 0 to 31 + 6 weeks of gestation were included. The primary outcome was a composite of mortality, severe intraventricular hemorrhage, severe necrotizing enterocolitis, cystic periventricular leukomalacia, and retinopathy of prematurity needing therapy. Secondary outcomes included additional neonatal outcomes. The odds ratio (OR) with corresponding 95 % confidence interval (CI) was calculated by logistic regression analysis for the year 2020 compared with 2018. ResultsComposite neonatal outcome did not differ between 2018 compared to 2020 (8.4 % (18/215) vs 8.2 % (25/306), OR 0.95; 95 % CI 0.51–1.77). No difference in composite neonatal outcome was found when analyzing groups as singletons (7.1 % vs 9.3 %, OR 1.35; 95 % CI 0.64–2.87), and multiples (13.3 % vs 5.9 %, OR 0.41; 95 % CI 0.13–1.26). ConclusionThere was no significant difference in composite neonatal outcome in pregnancies resulting in spontaneous PTB between 30 and 32 weeks of gestation in 2018 (with tocolysis) compared to 2020 (no tocolysis). These results support the protocol adjustment to withhold tocolytic treatment in women with threatened PTB above 30 weeks of gestation.

Challenging cases in rheumatic disease pregnancy: management perspectives from reproductive rheumatologists

Pregnant women with rheumatic and musculoskeletal diseases (RMDs) have a higher risk of adverse pregnancy and perinatal outcomes compared to those without RMDs. Although evidence-based guidelines have been developed for the reproductive health care and management of these individuals, multiple areas of uncertainty exist around the diagnosis and treatment of pregnant patients with confirmed or suspected RMDs. We present a series of outpatient cases that address areas of uncertainty in the field of reproductive rheumatology. Expert opinions were elicited from rheumatologists who have expertise in the reproductive health of individuals with RMDs to build new understanding around diagnosis or treatment approaches. The cases focused on the interpretation of antiphospholipid antibodies in various clinical scenarios, diagnosis and management of nephrotic-range proteinuria during pregnancy, and the use of tumor necrosis factor inhibitors during pregnancy. Our objective was not to replace existing guidelines and classification criteria but rather to provide a range of expert opinions that rheumatologists might consider when tailoring treatment and care for patients, particularly in challenging situations with limited data.

What is the best mode of delivery in nulliparous, singleton, term, vertex pregnancies

With approximately 145 million births occurring worldwide each year—over 30 million by cesarean delivery (CD), the need for evaluation of maternal and perinatal outcomes in different delivery scenarios is more pressing than ever. Recently, in a meta-analysis of the available randomized controlled trials, planned CD was associated with significantly decreased rates of low umbilical artery pH, and neonatal complications such as birth trauma, tube feeding, and hypotonia when compared to planned vaginal delivery (VD). Among singleton pregnancies, planned CD was associated with a significantly lower rate of perinatal death. For mothers, planned CD was associated with significantly less chorioamnionitis, more wound infection, and less urinary incontinence at 1 to 2 years. Conversely, planned VD has been associated with benefits such as a lower incidence of wound infection and quicker postpartum recovery compared to planned CD. Nonetheless, several risk factors for CD are increasing—such as older maternal age, obesity, diabetes, excessive gestational weight gain, and birth weight—while maternal pelvises are getting smaller. Concerns about the potential long-term risks of multiple cesarean deliveries, such as placenta accreta spectrum disorders, highlight the need for a balanced evaluation of both delivery modes. However, the total fertility rate is decreasing in the US and around the world, with many people wanting two or fewer babies, which decreases future risk of placenta accreta incurred by multiple cesarean deliveries in these individuals. Furthermore, one in four obstetricians-gynecologists has undergone a CD on maternal request for their nulliparous, singleton, term, vertex (NSTV) pregnancy, and CD rates less than about 19% have been associated with higher perinatal and maternal mortality. Thus, we propose that it is imperative that we prioritize conducting randomized trials to compare planned cesarean to planned VD for NSTV pregnancies. Such trials would need to include 8000 or more individuals; they would ideally follow each participant to the end of their reproductive life and study perinatal and maternal outcomes, including nonbiologic outcomes such as patient satisfaction, postpartum depression, breastfeeding rates, mother-infant bonding, post-traumatic stress, and cost-effectiveness. The time for such a trial is now, as it holds the potential to inform and improve obstetrical care practices globally.

Comparing Perinatal Outcomes of Assisted Reproductive Technology (ART)-Induced vs. Naturally Conceived Twin Pregnancies.

The occurrence of multiple pregnancies is consistently and significantly linked to the growing use of assisted reproductive technology (ART). Even very young women opt for having multiple embryos implanted by medical professionals in order to increase the chances of a successful outcome. Our aim is to review the research on cesarean section rates and perinatal outcomes, like perinatal morbidity, risk of preterm delivery, and low birth weight (LBW) of neonates in multiple pregnancies that resulted from ART in comparison to those that were naturally conceived. We conducted a comprehensive search of the PubMed, Crossref, and Google Scholar electronic databases for related articles up to January 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that most studies found no relationship between ART procedures and poor perinatal outcomes in multiple pregnancies compared to naturally conceived ones. A few studies have linked ART services to preterm birth (PTB) and LBW. Careful interpretation of these findings is necessary since confounding factors may invalidate the putative link. Although perinatal death rates are similar, ART increases cesarean section rates. When a statistically significant difference was detected, it was typically attributable to confounding variables such as maternal age, subfertility reasons, or maternal comorbidities like gestational diabetes or hypertension.

Enfermedad microvascular coronaria en gestante con antecedente de síndrome antifosfolípidos

Objective: to report the case of a pregnant woman with antiphospholipid syndrome history, in whom coronary microvascular disease was documented. Antenatal medical treatment improved prognosis and maternal and perinatal outcomes. Case: multigravida woman, 29.6 weeks pregnant, diagnosed with acute coronary syndrome, referred from a first level hospital. Diagnostic workup revealed microvascular disease. After receiving adequate management, she was discharged from hospital and included in the high-risk pregnancy program. Results: the diagnosis was made based on echocardiography, electrocardiography, troponin levels and cardiac catheterization. Anti-ischemic therapy was indicated considering the risk-benefit trade-off; management with aspirin was continued and the baby was born healthy. Conclusions: coronary microvascular disease should be considered, as a differential diagnosis in a pregnant woman with chest pain and history of antiphospholipid syndrome. Patients benefit from receiving antiplatelet and anticoagulant therapy soon after the diagnosis is made. Studies are required to evaluate the safest and most effective management of this condition.

Association between maternal religious service attendance and pregnancy loss in the United States: a secondary analysis of the Future Families & Child Wellbeing Study.

Accumulating evidence suggests that spirituality and religiosity may be associated with improved health outcomes. However, few studies have examined maternal religiosity as a protective factor for perinatal outcomes. We explored the association between maternal religious attendance and pregnancy loss. Data were drawn from the Future Families & Child Wellbeing Study's first and second waves and medical records (n=1874). Religious attendance was a self-reported response to the question "About how often do you attend religious services?" Pregnancy loss was measured from responses to the second wave survey question, "Since focal child's birth, have you had any miscarriages/abortions/stillbirths?" Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between maternal religious attendance frequency and pregnancy loss, overall and by race. Models were adjusted for sampling weights, religious preference, socioeconomic and behavioral factors. 8% (n=164) of mothers reported having a pregnancy loss. Of those with a pregnancy loss, 28% (n=46) attended services hardly ever and 20% (n=20) attended services once a week or more. Women who attended services more frequently had 58% increased odds of not experiencing a pregnancy loss (OR:1.58;95%CI:1.01,2.48) after adjusting for potential confounding. A post hoc analysis found no difference in pregnancy loss type or subsequent reproductive history based on attendance level. Results suggest that higher maternal religious attendance frequency may be a protective factor for pregnancy loss. Further research is needed to understand the association between maternal religious attendance and mechanisms for pregnancy loss.