This study aims to analyze rates of postpartum hemorrhage according to body mass index (BMI) and investigate relative risks for postpartum hemorrhage based on BMI. We conducted a retrospective chart review of all deliveries occurring in 2022 at two large urban hospitals in Indianapolis, IN, resulting in a cohort of 5,686 patients. After excluding patients for missing data, a total of 4,493 patients were included in the final analysis. Patients were categorized according to the Centers for Disease Control and Prevention (CDC) BMI definitions. We analyzed rates of postpartum hemorrhage according to patient variables. The rates of postpartum hemorrhage for patients with BMI categorized as healthy weight, overweight, Class I obesity, Class II obesity, and Class III obesity were 16.3, 19.6, 23.0, 21.3, and 27.7%, respectively (p < 0.0001). Relative risk for postpartum hemorrhage by BMI categories was investigated using logistic regression analysis, where patients in the healthy weight cohort (BMI 18 to <25) were used as the reference for risk of postpartum hemorrhage. We found that patients with Class III obesity had an increased risk of postpartum hemorrhage by 57% after adjusting for mode of delivery and race (adjusted risk ratio [aRR] = 1.57, 95% CI: 1.20-2.04). Despite increased relative risk in all categories, we found no statistical significance for patients with BMI in the overweight category (aRR = 1.19, 95% CI: 0.92-1.54) or the Class II obesity category (aRR = 1.24, 95% CI: 0.05-1.63). This study shows a significantly increased risk of postpartum hemorrhage among obese patients, particularly those with Class III obesity. Notably, we did not observe a dose-dependent effect of BMI on rates of postpartum hemorrhage, as there was, in fact, a marginal decrease in rates of postpartum hemorrhage when comparing Class I and Class II obesity. This study supports risk-based initiatives to address increasing postpartum hemorrhage rates in the United States. · The relationship between obesity and postpartum hemorrhage was investigated.. · There was an increase in postpartum hemorrhage after 40+ BMI.. · Mode of delivery and maternal age also alter postpartum hemorrhage risk.. · These data support the use of risk-assessment tools for obesity..

Maternal and neonatal outcomes in pregnant patients with Brugada Syndrome - a multicentre retrospective study (2014-2025).

Evaluation of the Implementation of a Checklist for the Management of Postpartum Hemorrhage Following Vaginal Delivery

Prophylactic oxytocin (5-10 IU) after vaginal birth is a grade A recommendation in France. During cesarean delivery, carbetocin is increasingly used as an alternative to oxytocin to reduce the risk and burden of postpartum hemorrhage (PPH). Its role after vaginal birth remains uncertain, largely because of higher costs. This study assessed the cost-effectiveness of carbetocin for PPH prevention in vaginal deliveries. We performed a retrospective single-center, observational before-after cohort study with a medico-economic component in a French tertiary maternity unit. All women who delivered vaginally between January 1 and March 31, 2024 (oxytocin period), and between November 1, 2024, and January 31, 2025 (carbetocin period), were included. These two periods corresponded to the institutional protocol change replacing oxytocin with carbetocin for prophylaxis of postpartum hemorrhage after vaginal delivery. A total of 1404 women were analyzed (702 per group). The overall PPH rate was similar between groups (9.0% vs. 7.8%). Severe PPH (≥1000 mL) occurred less frequently with carbetocin than with oxytocin (1.3% vs. 3.0%, P = 0.0244). Weighted mean costs per patient were €17.28 in the carbetocin group and €9.07 in the oxytocin group, with a mean difference of €8.11 (95% confidence interval [CI]: 0.31-15.48). The incremental cost-effectiveness ratio (ICER) was €511.87 per severe PPH avoided. Despite higher drug costs, prophylactic carbetocin significantly reduced severe PPH compared with oxytocin and showed favorable cost-effectiveness in vaginal deliveries. These findings support carbetocin as a valuable alternative for PPH prevention in this setting.

Severity of admission anemia and risk of postpartum hemorrhage: a single-center retrospective cohort study (2024-2025).

The risk of placenta accreta spectrum (PAS) associated with in vitro fertilization and embryo transfer (IVF-ET) in the context of mid-trimester pregnancy loss remains unclear. This study aimed to investigate the impact of IVF-ET on the incidence of PAS and identify the risk factors among women undergoing pregnancy loss following fetal demise or inevitable miscarriage during the second trimester. In our retrospective cohort study, we analyzed women who experienced second-trimester fetal loss due to fetal demise or inevitable miscarriage at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2013 and October 2023. The participants were categorized into IVF-ET (n = 93) and non-IVF-ET (n = 134) groups. The primary outcome was the incidence of PAS, which was diagnosed clinically or pathologically. Secondary outcomes included morbid PAS, postpartum hemorrhage, and other complications. Our results indicated that the IVF-ET group had a significantly greater risk of experiencing PAS (39.8% vs 17.9%, P < .001) and morbid PAS (17.2% vs 3.7%, P < .001) compared to the non-IVF-ET group. The median postpartum blood loss was greater (230.0 [120.0-600.0] mL vs 120.0 [70.0-200.0] mL, P < .001), and the rates of postpartum hemorrhage (30.1% vs 12.7%, P = .001) and retained products of conception persisting >4 weeks (38.7% vs 19.4%, P < .001) were also greater in the IVF-ET group. Multivariate analysis revealed IVF-ET (adjusted odds ratio [aOR] = 3.13; P = .002), a hysteroscopic history (aOR = 3.58; P = .02), and uterine abnormalities (aOR = 3.74; P = .02) as independent risk factors for PAS. In the IVF-ET group, compared with fresh embryo transfer, cryopreserved embryo transfer (aOR = 3.52; P = .01) was associated with a markedly higher risk of PAS (50.9% vs 22.2%, P = .006) and remained an independent risk factor after adjustment (aOR = 3.52; P = .01). Among women with mid-trimester pregnancy loss, those who underwent IVF-ET, especially cryopreserved embryo transfer, had a high risk of PAS, leading to increased hemorrhagic morbidity and complications. These findings highlight the need for enhanced preoperative assessment, vigilant management, and strategies to preserve fertility in this high-risk population.

Based on the hypothesis that the effect of general anesthesia (GA) vs. neuraxial anesthesia (NA) on postpartum hemorrhage (PPH) varies according to its underlying etiology, this study aimed to investigate the impact of the anesthetic technique on the risk of severe PPH indistinct clinical scenarios: (1) emergency cesarean deliveries at risk for uterine atony and (2) cases of placenta accreta spectrum (PAS) at risk for massive surgical hemorrhage. In this retrospective dual-cohort study, patients receiving GA in Cohort 1 were matched 1:3 to NA patients using propensity score matching (PSM). Cohort 2 comprised patients with PAS who underwent scheduled cesarean hysterectomy. The primary endpoint was severe PPH, and the results were analyzed statistically. In the matched Cohort 1 (n = 600), the incidence of severe PPH was significantly higher in the GA group compared to the NA group (21.3 vs. 9.8%). After adjusting for operative duration and tranexamic acid use, GA was independently associated with an almost threefold increased risk of severe PPH [Adjusted Odds Ratio (aOR): 2.91; 95% Confidence Interval (CI): 1.80-4.69; p < 0.001]. In contrast, in Cohort 2 (n = 75), the rate of severe PPH was high in both groups, with no significant difference observed (91.1 vs. 86.7%; p > 0.05). However, post-hoc Bayesian analysis indicated a > 99 and 91% probability that GA is associated with increased blood loss in Cohort 1 and Cohort 2, respectively. In our matched cohort, general anesthesia was associated with an almost threefold increase in the risk of severe PPH in emergency cesarean deliveries susceptible to uterine atony. In cases such as the placenta accreta spectrum, the primary determinant of hemorrhage is the underlying surgical pathology, and the role of anesthetic management appears to be secondary. However, these findings for the PAS cohort should be considered exploratory due to the small sample size. In general, these results strongly support the personalization of anesthetic strategies based on the expected etiology of hemorrhage to reduce maternal morbidity and mortality.

Effect of Assisted Reproductive Technologies in Women With Cardiovascular Disease.

Prevention of postpartum hemorrhage in moderate and high-risk patients: Addition of prophylactic misoprostol.

Pregnancy Outcomes in Women With Cardiovascular Disease:A Retrospective Cohort Study from Kaiser Permanente Northern California.

ABSTRACTBackgroundGuidelines for managing a small symphysial fundal height (SFH) measurement during pregnancy are well established, but guidelines identifying and managing a large SFH measurement at term are not.AimsTo determine the relationship between a large SFH at term and intra‐partum risk, and to determine if there is an SFH cut‐off that could predict the following adverse outcomes: emergency caesarean section (CS), instrumental delivery, postpartum haemorrhage (PPH) and admission of neonate to the special care nursery (SCN).Materials and MethodsA retrospective audit was performed on 775 deliveries at a regional Australian hospital. SFH measurement at term was the primary variable for investigation. The largest measurement taken within 14 days of delivery was accepted as the primary SFH measurement.ResultsIn primiparous women, an SFH of 36 cm was associated with the lowest incidence of emergency CS (8%) and 35 cm was associated with the lowest incidence of PPH (8%). Both risks trebled at an SFH of 40 cm (24%) and quintupled at 43 cm (42%). In multiparous women the emergency CS rate was not correlated with SFH, but the PPH rate was correlated.ConclusionsA SFH measurement at term is currently a neglected but useful measurement for triaging women early in labour. An SFH of 36 cm is most reassuring as the parturient is at low risk of an emergency CS or a PPH whereas a SFH of 40 cm or more indicates increased risk and intra‐partum care should be modified to reflect this increased risk.

This study aimed to characterize the risk of adverse pregnancy outcomes among patients with congenital uterine anomalies (CUA) using electronic health record data.Retrospective cohort study utilizing the TriNetX analytics research network, including female patients aged 10 to 55 with a documented singleton and intrauterine pregnancy.A total of 561,440 patients met inclusion criteria, of whom 3,381 (0.6%) had one or more International Classification of Diseases (ICD) encounter diagnosis codes for CUA. Compared with patients with no documented ICD encounter diagnosis of CUA, patients with CUA had lower rates of live birth (odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.33-0.38). CUA patients had higher rates of preterm labor (OR: 1.41, 95% CI: 1.20-1.65), fetal malpresentation (OR: 2.48, 95% CI: 2.16-2.85), and postpartum hemorrhage (OR: 1.54, 95% CI: 1.31-1.80). Severe maternal morbidity (SMM) was increased in patients with CUA, including for hysterectomy (OR: 3.41, 95% CI: 1.26-9.17) and acute renal failure (OR: 1.97, 95% CI: 1.08-3.57).Patients with CUA are at higher risk of adverse pregnancy outcomes compared with patients with normal uterine anatomy, including for SMM and postpartum complications. These patients should be counseled about these possible risks, and CUA should be incorporated into risk-stratification and prevention strategies. · Adversary pregnancy outcomes are higher with CUAs.. · CUA patients have higher risk of preterm delivery.. · CUAs are linked to higher rates of fetal malpresentation.. · Markers of SMM increased in patients with CUA.. · Enhanced screening and high-risk delivery care are encouraged..

This study aimed to evaluate maternal and neonatal outcomes of women who had chorioamnionitis during their primary term cesarean delivery (CD), in their subsequent delivery.This multicenter retrospective cohort study (2005-2022) included women who attempted trial of labor after CD (TOLAC) following a primary term emergency CD. Women were grouped by the presence or absence of chorioamnionitis at the primary CD. Primary outcome was mode of delivery in the subsequent delivery. Secondary outcomes included adverse maternal and neonatal outcomes, including uterine rupture and adhesions. Multivariable logistic regression identified predictors of recurrent chorioamnionitis and adverse outcomes.Of 2,626 women included, 258 (9.8%) had chorioamnionitis during their primary CD (Chorio-PCD). In the subsequent delivery, this group as opposed to women without chorioamnionitis, had higher rates of emergency repeat CD (31.4 vs. 24.3%, p = 0.012), recurrent chorioamnionitis (14.3 versus 5.1%, p < 0.001), and postpartum readmission (2.3 vs. 0.5%, p = 0.006). Nevertheless, having previous chorioamnionitis did not impact the rate of uterine rupture among women who attempted TOLAC. Among women undergoing repeat non-elective CD, rates of severe adhesions (38.3 vs. 25.6%, p = 0.016) and postpartum hemorrhage (13.6 vs. 6.9%, p = 0.034) were significantly higher in the Chorio-PCD group. Chorio-PCD in previous pregnancy independently predicted composite adverse maternal outcome (aOR = 1.50, 95% CI: 1.13-1.99, p = 0.005).Chorioamnionitis at primary term CD is associated with increased maternal morbidity in subsequent delivery. These findings support the need for careful delivery planning and postpartum management in this population. · Chorio-PCD linked to emergency CD in univariate, but not in multivariate, analysis.. · Chorio-PCD was significantly associated with adverse maternal outcomes at the subsequent delivery.. · Chorio-PCD was not associated with increased risk of preterm delivery or uterine rupture..

This study aimed to investigate pregnancy outcomes after conservative treatment for severe postpartum hemorrhage (PPH) following cesarean delivery (CD). A total of 9,366 women who underwent CD for two consecutive pregnancies were included. Bakri balloon tamponade was employed in 87 women, and compression sutures were used in 87 women to control PPH during the first CD. The subsequent pregnancy outcomes and operative findings during the second CD were compared among the groups. The preterm delivery rate was 3.2% in the control group, 12.6% in the Bakri group, and 11.5% in the compression suture group (P < 0.001). The rates of placenta accreta (1.4% vs. 1.3% vs. 5.3%, P = 0.017), PPH (0.9% vs. 3.9% vs. 8.0%, P < 0.001), and pelvic adhesions (5.2% vs. 6.5% vs. 13.3%, P = 0.004) were significantly greater in the compression suture group. After adjustment, conservative treatment increased the rate of preterm birth in subsequent pregnancies threefold. A compression suture increased the risk of placenta accreta by fourfold and the incidence of pelvic adhesions by more than twofold in subsequent CD. Conservative treatment for PPH following CD is associated with an increased risk of subsequent preterm birth. Women receiving compression sutures have an increased risk of placenta accreta and pelvic adhesions in subsequent pregnancies.

There are several maternity care models in Australia providing varying levels of continuity of care in the private and public maternity system. These were disrupted to varying degrees during the pandemic. To examine the impact of the five main maternity care models in Australia on perinatal outcomes for women who gave birth during the COVID-19 pandemic and their babies. A national survey, was conducted from March to December 2020, and again from August 2021 to March 2022. A weighted sample of 3682 postnatal women provided information on birthing outcomes. Survey tabulations of prevalence and weighted logistic regressions examined associations between five models of maternity care and perinatal outcomes. Compared with standard care, continuity of care in both public (MWCOC) and private midwife (PPM) models was associated with higher odds of: spontaneous labour (MWCOC AOR 1.66; CI 1.35-2.04; PPM AOR 11.01; CI 0.6.29-19.28), spontaneous vaginal birth (MWCOC AOR 1.84; CI 1.49-2.28; PPM AOR 3.14; CI 2.08-4.73), postnatal midwife visits at home, feeling supported postnatally, feeling the care provider showed commitment, and feeling known by the care provider; as well as lower odds: of induction, elective and emergency caesarean section, augmentation with oxytocin, perceived traumatic birth (MWCOC AOR 0.57; CI 0.45-0.73; PPM AOR 0.49; CI 0.31-0.77), fetal distress, and infant admission to special/neonatal intensive care. Compared to standard care, private obstetric care was associated with lower rates of postpartum haemorrhage, perceived traumatic birth (AOR 0.56; CI 0.45-0.69), spontaneous labour (AOR 0.45; CI 0.37-0.54), spontaneous vaginal birth (AOR 0.54; CI 0.45-0.65), postnatal home visits from a midwife, and higher rates of elective caesarean section (AOR 2.65; CI 2.12-3.30). Continuity of midwifery care models are associated with lower intervention rates and birth trauma compared to standard care. However, for women who seek, or are not concerned about increased obstetric intervention, private obstetric care also leads to lower rates of birth trauma when compared to standard care. Continuity of care models should be prioritised in future disaster events.

Operative vacuum delivery (VD) is often used to expedite safe vaginal births for various reasons, including maternal exhaustion (MEX), which accounts for about 30% of cases. This study identifies risk factors associated with vacuum deliveries for MEX and evaluates maternal and neonatal outcomes compared to other indications.A retrospective cohort study analyzed singleton-term vacuum deliveries from 2011 to 2022 at a tertiary care center, categorizing patients into two groups: Those with MEX (group 1) and those without (group 2). Statistical analyses included chi-square tests, t-tests, Mann-Whitney tests, and multivariable logistic regression.Out of 2,950 vacuum deliveries, 819 (27.8%) were indicated for exhaustion. Exhausted mothers were more likely to be nulliparous (75 vs. 71%, p = 0.028), have gestational diabetes (7.7 vs. 5.4%, p = 0.047), and use regional anesthesia (92.4 vs. 89.1%, p = 0.006). They also experienced longer labor durations, with a second stage averaging 2.86 hours versus 2.54 hours in the non-exhausted group (p < 0.001). While postpartum hemorrhage and chorioamnionitis rates were higher in the exhaustion group, neonatal outcomes did not differ significantly. The duration of the second stage was found to increase the odds of MEX by 53% for each additional hour (OR = 1.53 [95% CI: 1.10-1.64]).Women in the exhaustion group had distinct characteristics linked to prolonged labor. Despite some complications, VD for MEX was safe for both mothers and neonates, suggesting a need for targeted interventions to mitigate exhaustion during labor. · Maternal exhaustion accounts for 30% of vacuum births.. · Higher maternal morbidity is observed in the exhaustion group.. · Neonatal outcomes are comparable between groups.. · Vacuum delivery for exhaustion remains a safe option.. · An intervention to reduce exhaustion is needed..

To assess the association between the risk of severe postpartum hemorrhage (PPH) and the annual twin delivery volume of maternity units. JUmeaux MODe d'Accouchement (JUMODA) was a national observational prospective population-based cohort of twin deliveries in 176 French maternity units performing more than 1500 annual deliveries. Our analysis included 7348 women who delivered after 32 weeks' gestation. The primary outcome was severe PPH. The exposure of interest was the volume of annual twin deliveries defined as the number of annual twin deliveries per center in the study population, divided in three terciles. We compared the risk of severe PPH in maternity units with a low or moderate annual twin delivery volume to high volume group and used a propensity score weighting approach to control for confounding. Severe PPH occurred in 3.5% of women in the low-volume group (4-24 twin deliveries per year), 4.2% in the moderate-volume group (25-47), and 5.0% in the high-volume group (48-184) (P = 0.081). After propensity score weighting, as compared to women delivering in the high-volume group, the risk of severe PPH did not significantly differ for those in the low-volume group (OR 0.73, 95% CI: 0.49-1.07) or in the moderate-volume group (OR 0.84, 95% CI: 0.63-1.12). Absolute risk difference was 1.64% (95% CI: -3.04-0.24) for the low- between high-volume group and -0.72% (95% CI: -3.04-0.24) for the moderate- versus high-volume group. Results were similar after stratifying by mode of delivery and when only very severe PPH was considered. Severe PPH rates in twin pregnancies do not differ by the annual twin delivery volume of the maternity hospital, which questions the relevance of using this characteristic to limit where women can give birth, provided that a skilled obstetric and onsite anesthesiology team are available. Caution is therefore warranted when generalizing these results to other healthcare settings, particularly in low- and middle-income countries, where health system organization, resource availability, may substantially differ.

Postpartum hemorrhage (PPH) is a leading global cause of maternal mortality and morbidity. This study utilizes global burden of disease (GBD) data to assess its long-term trends in incidence, mortality, and disability-adjusted life years (DALYs). Using data from the GBD, we analyzed age-standardized incidence, mortality, and DALY rates among reproductive-aged women (15-49 years). Trend analysis was conducted via Joinpoint regression to estimate annual percentage changes (APCs), while future burden projections were modeled using Bayesian age-period-cohort (BAPC) analysis. From 1990 to 2021, the global age-standardized incidence rate (ASIR) of PPH declined significantly from 998.26 (95% UI: 654.55-1,438.33) to 722.16 (95% UI: 482.99-1,022.71) per 100,000 population. The estimated annual percentage change (EAPC) was -0.83% (95% UI: -0.90% to -0.77%). Projections suggest this downward trend will continue, with ASIR expected to reach 321.17 (95% UI: 302.55-359.30) by 2035. In 2021, women aged 20-24 years continued to exhibit the highest DALYs, amounting to 749,063 years (95% UI, 629,108.37-894,035.97). From 1990 to 2021, the proportion of DALYs among women of reproductive age attributable to iron deficiency-related PPH increased from 17.19% (95% UI, 8.65% to 21.48%) to 17.96% (95% UI, 8.67% to 23.95%). A sustained decline in the incidence of PPH over the past thirty years-a trend projected to continue through 2035, reflecting the ongoing effectiveness of public health interventions. We also found a potential association with iron deficiency, alongside a consistently higher disease burden observed among women aged 20-24 years.

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality globally, including in Indonesia, where it accounts for 30.3% of maternal deaths. While PPH often occurs suddenly, its risk can be predicted at the time of hospital admission through systematic screening. However, the effectiveness of such screening depends on healthcare worker compliance, which can be hindered by administrative burdens. This study aims to evaluate the effectiveness of implementing a digital-based PPH admission screening tool in improving staff compliance and reducing PPH incidence at Muhammadiyah Gresik Hospital. Using an action research methodology under the Plan-Do-Study-Act (PDSA) framework, the study was conducted in two cycles. Cycle 1 employed a manual (paper-based) screening form, while Cycle 2 introduced a fully digital format. The study population included all maternity patients admitted during the intervention periods, with total sampling applied. Data were collected through direct observation, medical record audits, and hospital quality reports, and analyzed descriptively by comparing compliance and PPH rates across cycles. The findings indicate that the transition to a digital format significantly increased staff compliance from 89% in Cycle 1 to 100% in Cycle 2. Importantly, this improvement in compliance was directly associated with a reduction in PPH incidence from 3% at baseline to 1% post-digital intervention. The study concludes that digital-based admission screening serves as a crucial cognitive aid for strengthening risk management and advancing toward the zero-preventable-harm patient safety target.

Anesthetic management of intrapartum cesarean deliveries with an in-situ epidural catheter during second-stage versus first-stage of labor: a single-center retrospective study (2022-2024).