Postpartum Hemorrhage Research Articles

Impact of maternal thyroid dysfunction on fetal and maternal outcomes in pregnancy: a prospective cohort study

BackgroundThyroid dysfunction in pregnancy can adversely impact maternal and fetal outcomes. However, the association between thyroid status and specific adverse outcomes needs clarity, especially in understudied regions.ObjectiveThis prospective cohort study aimed to illuminate the multifaceted associations between maternal thyroid dysfunction and feto-maternal outcomes in Gujarat, India.MethodsThis hospital-based cohort study recruited and monitored 500 euthyroid, 250 hypothyroid, and 150 hyperthyroid pregnant women until delivery. Maternal thyroid status was determined by serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels. Adverse fetal outcomes included preterm birth, neonatal intensive care unit (NICU) admission, respiratory issues, and low APGAR scores. Maternal outcomes included preeclampsia, haemorrhage, hypertension, postpartum thyroiditis, and thromboembolism. Relative risks quantified associations between thyroid dysfunction and outcomes.ResultsCompared to euthyroid women, hypothyroid women had a higher RR for preterm birth (RR 1.8, 95% CI 1.1–3.0), low APGAR score (RR 2.5, 95% CI 1.5–4.1), preeclampsia (RR 3.0, 95% CI 1.9–4.8), postpartum haemorrhage (RR 1.6, 95% CI 1.2–2.1), and venous thromboembolism (RR 3.1, 95% CI 1.7–5.7). Hyperthyroid women had over twice the risk of low APGAR score (RR 1.8, 95% CI 0.9–3.5), neonatal hypoglycemia (RR 1.5, 95% CI 0.5–4.3), respiratory distress (RR 1.4, 95% CI 0.7–2.8), and postpartum thyroiditis (RR 2.3, 95% CI 1.1–4.8).ConclusionMaternal thyroid dysfunction escalates risks for adverse fetal and maternal outcomes. Thyroid monitoring and management during pregnancy are critical to mitigate complications.

Investigating the causes of maternal mortality in Razavi Khorasan based on forensic medical records during the years 2015 to 2022

BackgroundMaternal mortality is among the main indicators of health in nations. Identifying the causes of maternal mortality is crucial in designing preventive interventions. Therefore, this study aimed to evaluate the causes of maternal mortality during 8 years.MethodsThis descriptive-analytical study was conducted on the archived cases of maternal mortality in the Forensic Medicine Department of the Khorasan Razavi Province between March 2013 and March 2022, but as no data was available for the first two years, maternal mortality data for 8 years was evaluated. Demographic characteristics, midwifery data, pregnancy care method, pregnancy care and delivery agent, insurance type, and confirmed cause of death were compared between the first and last five-year periods of the study.ResultsOverall, 250 cases of maternal mortality were identified in the study period. The prevalence of indirect and unrelated causes of maternal mortality was significantly higher in the last four-year period compared to the first four-year period (p < 0.001). The most common direct causes of maternal mortality in both periods were postpartum hemorrhage, eclampsia and gestational hypertension complications; and postpartum infection. Coronavirus disease 2019 (COVID-19) was the most common cause of maternal mortality in the last four-year period but the other common indirect causes of maternal mortality (cardiovascular disease and pulmonary embolism) were similar between the two periods. The most common unrelated cause of maternal mortality was accidents.ConclusionsPostpartum maternal mortality was higher than intrapartum period. Bleeding was still the main cause of maternal mortality. Despite the progress in prenatal care, it is necessary to improve intrapartum and postpartum quality of care.

Analysis of pregnancy and neonatal outcomes in 100 pregnant women with Rh-negative blood type

BackgroundThis study aimed to explore variations in prenatal care, delivery methods, influencing factors, and neonatal outcomes among Rh-negative pregnant women, so as to improve pregnancy healthcare for this demographic, raise the quality of maternal–fetal management, and safeguard the health of both mother and infant.MethodsThis study included 200 women who received routine prenatal care, exhibited no other pregnancy complications, and were admitted for delivery. They were divided into an observation group (100 Rh-negative blood type) and a control group (100 Rh-positive blood type). The study examined differences in pregnancy management, clinical characteristics and pregnancy outcomes between the two groups.ResultsThe results indicated that singleton pregnancies in Rh-negative mothers are associated with significantly higher rates of postpartum blood loss (305.1 ± 183.8 vs. 246.1 ± 84.9 mL, P = 0.004), neonatal hyperbilirubinemia (39% vs. 23%, P = 0.014), low birth weight (11% vs. 2%, P = 0.01), and NICU admission (30% vs. 18%, P = 0.046) compared to the control group. Among Rh-negative mothers, subgroup analysis by ethnicity revealed a higher incidence of fetal distress in the other ethnic groups compared to the Han and Zhuang groups (16.7%, 0, 6.5%, respectively, P = 0.025). Subgroup analysis based on ABO blood type within Rh-negative mothers did not show any statistical significance in various outcomes (all P > 0.05). Infants with neonatal hyperbilirubinemia born to Rh-negative mothers experienced a quicker resolution of hyperbilirubinemia compared to those whose mothers did not receive intramuscular anti-D immunoglobulin [1.0 (1.0, 1.5) vs. 5.0 (1.5, 10.0), P = 0.002].ConclusionsThe Rh-negative blood type is linked to higher risks of neonatal hyperbilirubinemia, low birth weight, and increased postpartum hemorrhage, resulting in detrimental pregnancy outcomes. Administering anti-D immunoglobulin speeds up the resolution of neonatal hyperbilirubinemia. Thus, prudent and efficient use of anti-D immunoglobulin can mitigate adverse outcomes for both mothers and newborns.

Immune changes in pregnancy: associations with pre-existing conditions and obstetrical complications at the 20th gestational week—a prospective cohort study

BackgroundPregnancy is a complex biological process and serious complications can arise when the delicate balance between the maternal and semi-allogeneic fetal immune systems is disrupted or challenged. Gestational diabetes mellitus (GDM), pre-eclampsia, preterm birth, and low birth weight pose serious threats to maternal and fetal health. Identification of early biomarkers through an in-depth understanding of molecular mechanisms is critical for early intervention.MethodsWe analyzed the associations between 47 proteins involved in inflammation, chemotaxis, angiogenesis, and immune system regulation, maternal and neonatal health outcomes, and the baseline characteristics and pre-existing conditions of the mother in a prospective cohort of 1049 pregnant women around the 20th gestational week. We used Bayesian linear regression models to examine the impact of risk factors on biomarker levels and Bayesian cause-specific parametric proportional hazards models to analyze the effect of biomarkers on maternal and neonatal outcomes. We evaluated the predictive value of baseline characteristics and 47 proteins using machine-learning models and identified the most predictive biomarkers using Shapley additive explanation scores.ResultsAssociations were identified between specific inflammatory markers and several conditions, including maternal age and pre-pregnancy body mass index, chronic diseases, complications from prior pregnancies, and COVID-19 exposure. Smoking during pregnancy affected GM-CSF and 9 other biomarkers. Distinct biomarker patterns were observed for different ethnicities. Within obstetric complications, IL-6 inversely correlated with pre-eclampsia risk, while birth weight to gestational age ratio was linked to markers including VEGF and PlGF. GDM was associated with IL-1RA, IL-17D, and eotaxin-3. Severe postpartum hemorrhage correlated with CRP, IL-13, and proteins of the IL-17 family. Predictive modeling yielded area under the receiver operating characteristic curve values of 0.708 and 0.672 for GDM and pre-eclampsia, respectively. Significant predictive biomarkers for GDM included IL-1RA and eotaxin-3, while pre-eclampsia prediction yielded the highest predictions when including MIP-1β, IL-1RA, and IL-12p70.ConclusionsOur study provides novel insights into the interplay between preexisting conditions and immune dysregulation in pregnancy. These findings contribute to our understanding of the pathophysiology of obstetric complications and the identification of novel biomarkers for early intervention(s) to improve maternal and fetal health.

Postpartum Hemorrhage

Abstract Obstetric hemorrhage is the leading cause of maternal death in childbirth; it is estimated that one woman dies every four minutes from postpartum hemorrhage (PPH). PPH is the cause of approximately one-quarter of maternal deaths worldwide and is thus a major public health issue of great importance. Despite modern advances in medicine, hemorrhage continues to lead the causes of pregnancy-related death in most countries, with increasing disparity between countries with highly developed and underdeveloped national healthcare systems. Most deaths caused by PPH are preventable. All involved in the care of pregnant women must be aware of the gravity of this problem, ways of identifying women at risk for severe hemorrhage at childbirth, strategies for preventing and ameliorating blood loss at delivery, and finally ways to deal with obstetric hemorrhage when it does occur. This article reviews the impact of obstetric hemorrhage, the controversy regarding definitions, diagnosis, epidemiology, pathophysiology, and management of obstetric hemorrhage.

ICNP® reference terminology for selected diagnoses and interventions in midwifery care on the example of a postpartum woman after hemorrhage with impending preeclampsia

Abstract Aim. The aim is to indicate the validity of implementing the ICNP® terminology in obstetric care on the example of a patient after postpartum hemorrhage with suspected preeclampsia. Based on the catalog of concepts, the entity’s problems and the midwife’s interventions were identified in the proposed individualized care plan. Material and methods. The research method in this work is an individual case study. The basis for the presented care plan was the use of techniques: interview, observation, analysis of medical documentation and measurements relevant for therapeutic purposes. This manuscript was developed based on the CARE protocol for case reports. Results. The presented care model allowed for the implementation of individualized interventions, resulting in the improved quality of life and a better prognosis in the subject’s recovery process. The role of a midwife in the care of a patient with the previously mentioned diseases indicates the indispensable affiliation to an interdisciplinary team, at the same time establishing an independent and autonomous profession. Conclusions. The use of the ICNP® classification promotes the development of nursing as a field of science. The indicated method allows for accurate interpretation of problems in the obstetric care, thus unifying the communication system based on databases and currently functioning catalogs of concepts.

The Effect of Immediate Kangaroo Mother Care During Third Stage of Labor on Postpartum Blood Loss and Uterine Involution: A Quasi-Experimental Comparative Study

Background: Obstetric hemorrhage is the leading cause of maternal death worldwide. Obstetric hemorrhage accounts for 27.1% of all maternal death worldwide. Of all obstetric hemorrhages, postpartum hemorrhage (PPH) accounts for 72%. The physiological management of the third stage of labor is a growing area as a preventive measure to control postpartum blood loss. Immediate kangaroo mother care (KMC) is suggested as one of the physiological management methods of the third stage of labor to reduce postpartum blood loss. The duration of the third stage of labor, uterine involution, and amount of postpartum blood loss are the physiological parameters of effective management of the third stage of labor. Examining the absolute effects of immediate KMC on maternal physiological parameters is needed in different populations with different settings. Thus, this study aimed to examine the effects of immediate KMC on uterine involution and postpartum blood loss. Methods: A quasi-experimental comparative design was conducted in the labor and delivery room at Maternity and Children Hospital, Makkah, Saudi Arabia. A sample of 80 women was divided into two equal groups: a treatment group that underwent immediate KMC and a control group that received routine care. Instrument: A questionnaire developed by the researchers was used to collect the data. Results: The effects of immediate KMC were significant concerning uterine involution and regarding the uterine position immediately after placenta separation (70% at umbilicus, χ2 = 8.5, p &lt; 0.01), postpartum blood loss (χ2 = 76.098, p &lt; 0.00), the heaviness of lochia (χ2 = 44.679, p = 0.00), and the number of pads used in the first 24 h (p &lt; 0.001).

Uterine artery embolisation in symptomatic patients with placenta accreta spectrum disorders.

Postpartum haemorrhage is the most common cause of mortality among women after childbirth. Therefore, this work aims to highlight the possibility of endovascular treatment of postpartum haemorrhage due to remnants in patients with placenta accreta spectrum disorders (PAS disorders) using selective UAE after failure of the standard management. This procedure is a relatively safe and technically nondemanding, with a low risk of recurrent vaginal bleeding. This article presents an evaluation of the results of eight patients (age between 19-39 years) who underwent selective transarterial embolisation of uterine arteries from January 2022 to August 2023 at the angio-interventional department of our university hospital center. Based on a multidisciplinary consensus of sonographically detected residues of placenta accreta with typical hypervascularisation, unilateral/bilateral embolisation of the uterine artery was performed with a microcatheter using polyvinyl alcohol embolisation particles, possibly in combination with gelatine foam. There were no periprocedural complications during embolisation, nor were there episodes of repeated bleeding or other postprocedural complications during the follow-up. Two patients underwent surgical revision of the uterine cavity with extirpation of devascularised residual tissue. Thus far, this procedure has proven to be a safe and relatively technically nondemanding method supplementing the management of symptomatic patients with PAS disorders with a low risk of rebleeding.

SURGICAL INTERVENTION IN SEVERE POSTPARTUM HAEMORRHAGE

Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality and morbidity, defined as haemorrhage occurring within 24 h of childbirth. Postpartum haemorrhage can be categorized into primary, which takes place within the first one day after childbirth, and secondary, which happens anytime from 24 hours after birth up to six weeks after delivery. Among the cases of PPH, some are severe and fatal and hence need to be treated effectively and on time. Conservative methods are to some extent useful in controlling PPH but surgical management involves the use of special operations to address the problem. Objective: This proposed study aims to finally summarize the evidence about surgical interventions in the management of postpartum haemorrhage, including the effectiveness and side effect profile of various surgical techniques. Methods: This study type used a retrospective cohort design and the sample consisted of patients with severe PPH that needed surgical management. This paper used quantitative data and the data was gathered from the records of hospitals for five years. Some of the surgical management activities considered in the study were uterine artery ligation, B-Lynch suture, and hysterectomy. The variables measured were success rates, early clinical outcomes, late clinical recovery and early complications. Quantitative methods of data analysis used in this study include survival analysis tests and chi-square tests. Results: The study enrolled 150 patients with severe manifested PPH; 60% of the patients underwent uterine artery ligation; 25% of the patients required a B-Lynch suture performed; and 15% of the patients required a hysterectomy. Short-term effects revealed that both techniques provided effective control of bleeding, in 85% of cases did not require additional surgery in the form of a B-Lynch suture. It was also shown that 70% of the cases with uterine artery ligation were associated with long-term preservation of fertility. Hysterectomy had the highest complication rates; infection, organ damage, and higher maternal mortality of 5%. Conclusion: Uterine artery ligation as well as B-Lynch suture should be used in cases of severe PPH because during this procedure no tubal sterilization occurs and fertility can be preserved when selecting the right cases. Although hysterectomy remains the surgical option of choice, the procedure is fraught with some significant risks. The study confirms the necessity for early surgical management and the collaboration of multiple specialists to optimise maternal results in grave cases of PPH. More clinical research is required to optimize surgical approaches and to define the role of non-operative interventions to improve the patient’s prognosis.

Correlation analysis of clinical characteristics of patients with postpartum hemorrhage.

Correlation analysis of clinical characteristics of patients with postpartum hemorrhage.

Characteristics of the pregnancy and labour course in women who underwent COVID-19 during pregnancy.

This study aims to analyze the impact of COVID-19 on pregnancy and labor, focusing on its effects on maternal and child health. The research explores the relationships between coronavirus infection and clinical and laboratory parameters, as well as the risks of pregnancy complications and adverse birth outcomes. The study involved 60 pregnant women diagnosed with COVID-19. A comprehensive evaluation of clinical and laboratory indicators was conducted, employing correlation, regression, logistic analyses to determine risk factors. There was a strong inverse correlation between carbon dioxide levels and haematocrit (-0.76), and a direct correlation between blood pH and partial pressure of oxygen (0.73). COVID-19 was associated with increased risks of preterm labor (OR=1.82), stillbirth (OR=2.11), pre-eclampsia (OR=1.46), and foetal distress. Multivariate analysis revealed a 200 g reduction in neonatal birth weight and higher risks of hospitalisation (OR=1.8), postpartum hemorrhage (OR=2.3), and preterm delivery (OR=2.5). Comorbid conditions such as cardiovascular abnormalities, diabetes, obesity, thrombophilias exacerbated the risks of complications, including pre-eclampsia, neonatal respiratory distress syndrome, venous thromboembolism. COVID-19 infection increases the likelihood of pregnancy complications and adverse outcomes, especially in women with comorbidities. These findings highlight the need for preventive strategies and risk management protocols for pregnant women during future outbreaks, emphasizing the importance of further research in this field.

β-Thalassemia minor is associated with high rates of worsening anemia in pregnancy.

We identified 347 pregnancies in patients with beta thalassemia minor. Hemoglobin was below 9 g/dL in 31% during third trimester and 7.6% at delivery. Postpartum hemorrhage occurred in 8.9%. Forty-six percent of intravenous iron administration was to iron-replete patients.

Meta-analysis: the prophylactic use of tranexamic acid to reduce blood loss during caesarean delivery.

The 2022 national guideline on The Prevention and Management of Primary Postpartum Haemorrhage (PPH) recommended consideration of prophylactic tranexamic acid (TXA) for women who are at high PPH risk undergoing caesarean section (CS). This meta-analysis reviews the basis for this recommendation. PubMed, OVID Medline, EMBASE, Science Citation Index, Scopus, CENTRAL, and ClinicalTrials.gov were searched (from inception to January 2024) for randomised controlled trials comparing prophylactic intravenous TXA with placebo or no treatment in women undergoing CS who received a uterotonic. Our main outcome was PPH > 1L. Secondary outcomes included estimated mean blood loss, blood transfusion, drop in haemoglobin, the need for additional uterotonics, or surgical intervention. Adverse effects of TXA were also assessed. Sixty-one studies including 25,098 women were identified, and 12,446 received prophylactic TXA. Patients who received prophylactic TXA had significantly reduced likelihood of PPH > 1L (RR, 0.47; 95% CI, 0.38 to 0.59), reduced estimated mean blood loss (MD 185.86 ml, 95% CI 159.14-212.59), and reduced drop in Hb (MD 0.84g/dl, 95% CI 0.72, 0.95). There was a significant reduction in need for additional uterotonics (RR 0.47, 95% CI 0.39-0.57) or surgical intervention (RR 0.54, 95% CI 0.30-0.95). The reduced risk of PPH > 1L was greatest in patients at higher risk of bleeding. The greatest risk reduction was seen in smaller studies and in studies undertaken in developing economies. Prophylactic TXA administration is effective at reducing the incidence of PPH > 1L at CS. The clinical benefit of universal prophylaxis is questionable; women who are high risk of PPH are more likely to derive benefit.

Cesarean section with operation on placental support as an adapted EXIT procedure for fetal thyroid goiter: A case report and literature review.

The ex-utero intrapartum treatment (EXIT) procedure is a specialized delivery strategy that extends utero-placental-fetal circulation to convert a potential neonatal emergency condition into a condition that is compatible with postnatal life. Cesarean section with operation on placental support is an EXIT technique that requires a relatively short duration of placental support and few skilled medical personnel and specialized instruments; it can successfully treat selected fetal indications. In the present study, we report a case of fetal thyroid goiter as an example of a fetal anomaly requiring the procedure. We then review all cases published in the medical literature that were similar to our procedure (15 cases including our new case). Twelve (80%) cases of fetal anomalies and three prophylactic cases of extremely low birth weight were delivered using a procedure adapted from the standard EXIT procedure. All 12 cases of fetal anomalies were treated by airway intervention. In 12 of the 15 cases (80%), direct laryngoscopy and endotracheal intubation were attempted; intubation was successful in seven of these 12 cases (58%). There was only one case of postpartum hemorrhage caused by uterine incisional bleeding, with a consequence of delayed hysterotomy closure. In summary, cesarean section with operation on placental support is a promising alternative delivery technique for neonates with airway obstructive lesions, especially in resource-limited settings.

A study of maternal and perinatal outcomes due to excessive maternal gestational weight gain in a district hospital in West Bengal – A cross-sectional study

Background: The weight gain that occurs in pregnancy has the potential to influence a woman’s long-term health by increasing the risk for weight retention and obesity, as well as related comorbidities such as chronic hypertension (HTN) or Type 2 diabetes mellitus. Aims and Objectives: The aim of the study was to study maternal and perinatal outcomes associated with excessive maternal gestational weight gain (GWG). Materials and Methods: The current study was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, from October 2018 to October 2019. A total of 91 women attending the antenatal clinic of MR Bangur Hospital and getting admitted for delivery during the study period was considered as the study population. Medical records were maintained for variables of the mothers such as gestational diabetes mellitus (GDM), gestational HTN, pre-eclampsia, eclampsia, duration of labor, mode of delivery, indication of cesarean section, Postpartum hemorrhage, and perineal tears. coGuide v.0.01 used for statistical analysis. Results: There were majority of 55 (60.4%) participants reported 18.5–24.9 body mass index (BMI). The difference in the proportion of BMI across maternal weight gain was statistically significant. The difference in the proportion of GDM, duration of labor &gt;18 h, and duration of the second stage of labor &gt;2 h between maternal weight gain were statistically significant. The difference in the proportion of APGAR score at 1 min, and 5 min between groups of maternal weight gain was statistically significant. Conclusion: Our study suggested that GWG has to be achieved within the Institute of Medicine recommendation according to pre-pregnancy BMI to improve pregnancy outcomes and reduce maternal and perinatal adverse outcomes.

Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.

Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications. This retrospective cohort study included women who underwent a cesarean delivery in New York State between January 2009 and December 2017. Women were followed for 1 year after discharge for readmission, outpatient visit, or ED visit. The primary outcome was PPD requiring readmission, outpatient visit, or ED visit. The 2 secondary outcomes were (1) PPD requiring readmission, and (2) suicidality. Obstetric complications included severe maternal morbidity, blood transfusion, postpartum hemorrhage, preterm birth, and stillbirth. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of PPD, PPD requiring readmission, and suicidality associated with GA were estimated using the propensity score matching and the overlap propensity score weighting methods. Of the 325,840 women included, 19,513 received GA (6.0%; 95% CI, 5.9-6.1). Complications occurred in 43,432 women (13.3%) and the GA rate for these women was 9.7% (95% CI, 9.4-10.0). The incidence rate of PPD was 12.8 per 1000 person-years, with 24.5% requiring hospital readmission, and was higher when an obstetric complication occurred (17.1 per 1000 person-years). After matching, the incidence rate of PPD was 15.5 per 1000 person-years for women who received neuraxial anesthesia and 17.5 per 1000 person-years for women who received GA, yielding an aHR of 1.12 (95% CI, 0.97-1.30). Use of GA was associated with a 38% increased risk of PPD requiring hospitalization (aHR: 1.38; 95% CI, 1.07-1.77) and with a 45% increased risk of suicidality (aHR 1.45; 95% CI, 1.02-2.05). Results were consistent when using the overlap propensity score weighting. Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.

NURSING CARE IN THE PREVENTION OF MATERNAL DEATHS DUE TO POSTPARTUM HEMORRHAGE

Postpartum hemorrhage is the main complication that occurs during childbirth, and can lead to shock and consequently death, and appropriate treatment is essential. It is characterized by the loss of large amounts of blood after childbirth due to the lack of contraction of the uterus after the birth of the baby. Hemorrhage is considered when a woman loses 500 mL of blood after vaginal delivery or 1000 mL of blood after cesarean section and the main causes of postpartum hemorrhage are: tone, trauma, tissue and thrombin. The objective of the research was to gather evidence on the characteristics, prevention, treatment and factors that contribute to postpartum hemorrhage. A narrative literature review was carried out with data collection in the Virtual Health Library (BVS), Medical Literature Analysis and Retrieval System Online (Medline) and the National Library of Medicine (Pubmed), using the following descriptors in English: Postpartum hemorrhage, Prevention and control, Maternal death. The study highlighted the importance of preventing and treating the disease, including screening for risk factors through prenatal care.

Abnormal microRNA expression profile at early stages of gestation in pregnancies destined to develop placenta previa.

Placenta previa is the abnormal implantation of the placenta into the lower segment of the uterus, is associated with adverse maternal and fetal outcomes such as placenta accreta spectrum disorders, antepartum and postpartum hemorrhage, fetal growth restriction, prematurity, stillbirth and neonatal death, thrombophlebitis, and septicemia. The aim of the study was to assess retrospectively how the later onset of placenta previa affects the microRNA expression profile in the whole peripheral blood during the first trimester of gestation. Regarding the occurrence of the association between aberrant microRNA expression profiles at early stages of gestation and later onset of various pregnancy-related complications, we selected for the study pregnancies developing placenta previa as the only pregnancy-related disorder. In total, 24 singleton pregnancies diagnosed with placenta previa that underwent first-trimester prenatal screening and delivered on-site within the period November 2012-May 2018 were included in the study. Overall, 80 normal pregnancies that delivered appropriate-for-gestational age newborns after completing 37 weeks of gestation were selected as the control group based on the equality of the length of biological sample storage. Downregulation of multiple microRNAs (miR-20b-5p, miR-24-3p, miR-26a-5p, miR-92a-3p, miR-103a-3p, miR-130b-3p, miR-133a-3p, miR-145-5p, miR-146a-5p, miR-155-5p, miR-181a-5p, miR-195-5p, miR-210-3p, miR-342-3p, and miR-574-3p) was observed in pregnancies destined to develop placenta previa. The combination of seven microRNAs (miR-130b-3p, miR-145-5p, miR-155-5p, miR-181a-5p, miR-210-3p, miR-342-3p, and miR-574-3p) showed the highest accuracy (AUC 0.937, p < 0.001, 100.0% sensitivity, 83.75% specificity) to differentiate, at early stages of gestation, between pregnancies with a normal course of gestation and those with placenta previa diagnosed in the second half of pregnancy. Overall, 75% of pregnancies destined to develop placenta previa were correctly identified at 10.0% FPR. Consecutive large-scale analyses must be performed to verify the reliability of the proposed novel early predictive model for placenta previa occurring as the only pregnancy-related disorder.

WOMAN-2: TXA has no role in postpartum hemorrhage

WOMAN-2: TXA has no role in postpartum hemorrhage

Broad-Spectrum Micronutrients or Antidepressants for Antenatal Depression: Effect on Maternal and Infant Birth Outcomes in an Observational Secondary Analysis of NUTRIMUM.

One-fifth of women experience antenatal depression. Untreated antenatal depression is associated with increased risk of adverse birth outcomes. This study investigated the effect of broad-spectrum micronutrients (BSM; vitamins and minerals), used to treat antenatal depression (NUTRIMUM trial), on birth outcomes. Birth outcomes of 129 mother-infant pairs were obtained from hospital medical records or personal health records for home births. Pairs from NUTRIMUM exposed to ≥8 weeks of BSM antenatally (MN; n = 55) were compared to pairs exposed to antidepressants antenatally (MED; n = 20) and a reference group (REF; n = 54) of pairs not exposed to trial BSM or antidepressants. Groups were comparable on demographic variables. At study entry, MN and MED had depression scores in the moderate range, statistically higher than REF (nonclinical range). MN and REF did not differ significantly for gestational age, preterm births, infant size, or infant resuscitation. There were significantly lower rates of postpartum hemorrhage in MN relative to REF (7.7% vs 30%; RR = 0.26, 95% CI [0.08-0.84]). Gestational age at birth was higher for MN (39.5 weeks) than MED (38.5 weeks; d = 0.67, 95% CI [0.15-1.20], P = 0.03) as well as infant birth length (52.2 vs 50.0 cm; d = 0.77, 95% CI [0.21-1.33], P = 0.02), and rates of infant resuscitation were lower (14.5% vs 45%; RR = 0.33, 95% CI [0.15-0.73]). Days of BSM exposure was positively associated with birth weight (r = 0.32, P = 0.008) and length (r = 0.25, P = 0.04). Micronutrients used to alleviate antenatal depression may mitigate negative effects of depression on birth outcomes and showed more favorable birth outcomes compared with antidepressants.