Adverse maternal and neonatal outcomes in extremely young mothers (≤ 17 years) versus women aged 20-35 years: a retrospective cohort study in Thailand.

To investigate risks of pregnancy and birth in patients with peripheral vascular malformations (VMs). Nationwide cross-sectional study. Tertiary referral centre and Dutch national patient organisation. Women aged ≥ 15 years diagnosed with peripheral VM of any subtype or anatomical location. Patients were invited to complete a comprehensive questionnaire about obstetric history and VM-related symptoms during pregnancy. Prevalence of complications, specifically worsening of VM-related symptoms during pregnancy, deep venous thrombosis (DVT), pulmonary embolism (PE) and postpartum haemorrhage (PPH). Two-hundred-six women completed the questionnaire. Among 108 patients, 248 pregnancies and 204 births were reported; 98 patients were nulligravid. DVT and PE occurred in 2.5% and 0.5% of total pregnancies, respectively and only occurred in patients with extensive VMs (> 30 cm) involving at least the lower extremities (predominantly Klippel-Trenaunay). PPH occurred in 19.6% of births, including in 63.6% of those with uterine involvement and 47.8% with genital involvement of the VM. VM-related symptom worsening and volume increase during pregnancy occurred in 47.6% and 45.4% of patients, respectively. In multivariable regression, AVM subtype (OR 4.0, 95% CI 1.0-15.1), genital region involvement (OR 4.6, 95% CI 1.5-13.8), and a history of puberty-related symptom progression (OR 2.6, 95% CI 1.1-6.2) were independently associated with VM-related symptom worsening during pregnancy. Women with VMs appear to have a significant risk of PPH and worsening of VM-related symptoms during pregnancy, especially if the genital region is involved. Increased thromboembolic risk appears confined to patients with extensive VMs involving the lower extremities.

Enhancing postpartum hemorrhage management in Sri Lanka: A pilot study to assess the impact and appropriateness, acceptability, and feasibility of a locally co-created quality improvement intervention.

Perinatal outcomes and care patterns after centralisation of acute obstetric care in three Dutch regions: a retrospective cohort study.

Severe maternal morbidity has been linked to maternal mortality and several perinatal complications, but the evidence on associations with children's neurodevelopmental disorders is still unclear. To assess associations between severe maternal morbidity and cerebral palsy in children, overall and by major severe maternal morbidity subtypes. Longitudinal cohort study of all live births in the province of Ontario, Canada, between 2003 and 2019 followed up through 2020 (n=2,136,816), under a single-payer healthcare system. Severe maternal morbidity (n=41,396) was identified from inpatient or emergency department diagnoses during the index pregnancy or postpartum (20 weeks gestation to 42 days postpartum) based on validated algorithms according to diagnostic and procedure codes. Severe maternal morbidity was categorized into severe hypertensive disorders of pregnancy (severe preeclampsia, Hemolysis, Elevated Liver enzymes, and Low Platelets syndrome, and eclampsia combined), severe hemorrhage (eg, antepartum or postpartum hemorrhage with coagulation defect, red cell transfusion, procedures to the uterus, or hysterectomy), sepsis (puerperal sepsis or septicemia during labor), and other severe maternal morbidities (eg, admission to intensive care, shock). Cerebral palsy in offspring was defined as a single inpatient or 2 or more outpatient diagnoses at least 2 weeks apart between birth and the end of follow-up (age, 1-17 years). Associations were estimated using Poisson regression models. Of 2,136,816 children included in this study (mean [standard deviation] gestational age, 38.9 [1.8] weeks; 1,074,548 males [51.3%]), 41,396 (2.0%) were exposed to severe maternal morbidity. In a median follow-up of 9.5 years (interquartile range, 5.2-13.7), 5352 children were diagnosed with cerebral palsy (0.3%), of which 272 cerebral palsy cases (0.7%) were exposed to severe maternal morbidity. The average annual cerebral palsy incidence rate was 7.5 per 10,000 child-years in those exposed to severe maternal morbidity and 2.5 per 10,000 in those unexposed. Children of mothers with severe maternal morbidity had an increased risk of cerebral palsy (rate ratio, 2.71; 95% confidence interval, 2.39-3.06) after adjusting for maternal sociodemographic and clinical characteristics. All severe maternal morbidity subtypes considered were associated with increased risks of cerebral palsy, with the strongest associations observed for severe hypertension disorders (adjusted rate ratio, 3.29 [2.44-4.33]). Other severe maternal morbidity subtypes also showed similarly increased risks (adjusted rate ratio for sepsis, 2.45 [1.86, 3.15]), severe hemorrhage 2.44 (1.89, 3.09), and other severe maternal morbidity subtypes (2.81 [2.30-3.39]). In this population-based study of more than 2 million births, severe maternal morbidity was associated with an increased risk of cerebral palsy. This risk was observed across major severe morbidity subtypes, including hypertensive disorders, hemorrhage, and sepsis. These findings highlight the potential benefits of optimizing maternal health and illustrate potential long-term adverse consequences of severe maternal morbidity in offspring. Children of mothers who experience severe or life-threatening events during the perinatal period may benefit from enhanced surveillance for early cerebral palsy symptoms.

Prenatal exposure to organophosphate esters: Evidence of sex-specific risks for maternal and neonatal health.

This review article discusses the most common umbilical cord vessel anomalies and umbilical cord emergencies, as well as their implications on anesthetic management. Umbilical cord anomalies and emergencies pose significant risks to both the fetus and the mother. Fetal complications can include fetal heart tone issues, hypoxia, preterm delivery, unexpected neonatal ICU admissions, exsanguination, and fetal demise. Maternal complications can include emergency cesarean delivery and postpartum hemorrhage. Recognition of these anomalies and their potential complications is essential to the proper management of these patients. Anesthesia providers must be familiar with and available for patients with various umbilical cord pathologies to provide safe and effective care for the best maternal and neonatal outcomes if umbilical cord emergencies arise. Coordinated efforts should be in place for multidisciplinary emergency response systems.

Crohn's disease, which typically affects individuals of reproductive age, has risen in prevalence over the past decades. The study objective was to determine the impact of maternal Crohn's disease on maternal and neonatal adverse outcomes. A retrospective cohort study was performed using the Healthcare Cost and Utilization Project-National Inpatient Sample from the UnitedStates. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify individuals who delivered between 2016 and 2021, and then those with Crohn's disease were identified (ICD-10 code K50). The effect of Crohn's disease on pregnancy was estimated using multivariable logistic regression adjusted for baseline maternal characteristics. There were 4,337,612 births between 2016 and 2021, of which 5,671 were associated with maternal Crohn's disease, for an overall period prevalence of 13.1/10,000 births. There was an upward trend in prevalence from 10.2/10,000 deliveries in 2016 to 15.6/10,000 deliveries in 2021 (p<0.0001). Individuals with Crohn's disease were at increased risk of preeclampsia (odds ratio 1.6, 95 % CI 1.4-1.7), chorioamnionitis (1.3, 1.1-1.5), placental abruption (1.4, 1.1-1.7), instrumental delivery (1.3, 1.1-1.4), cesarean delivery (1.6, 1.5-1.7), postpartum hemorrhage (1.3, 1.2-1.5), sepsis (2.0, 1.5-2.7), and venous thromboembolic events (2.1, 1.1-3.8). Neonates born to these mothers were more likely to be premature (1.6, 1.5-1.7), suffer from congenital anomalies (1.5, 1.2-1.8) and intrauterine growth restriction (1.7, 1.5-1.9). Crohn's disease in pregnancy was associated with adverse maternal and neonatal outcomes. Pregnant patients with Crohn's disease should therefore be closely monitored throughout their pregnancy to minimize these adverse outcomes.

Compared with early cord clamping (ECC), delayed cord clamping (DCC) facilitates improved placental transfusion and increases blood volume in singleton pregnancies. However, evidence supporting the use of DCC in twins delivered by cesarean section is limited. The objective of this study was to evaluate the impact of DCC versus ECC on both maternal and neonatal outcomes in twin pregnancies delivered through cesarean section. We conducted a retrospective cohort study that included 280 twin pregnancies at ≥28 weeks that were delivered by cesarean section. A comparison of maternal bleeding complications and neonatal hemoglobin and hematocrit levels, hyperbilirubinemia, and neonatal morbidity outcomes was conducted between the DCC and ECC groups. Among the study cohort, 135 (48.2%) twin pregnancies were in the DCC group, while 145 (51.8%) received ECC. The mean reduction in maternal hemoglobin was significantly greater in the DCC group than in the ECC group (DCC 1.0±1.1 g/l vs. ECC 0.7±1.3 g/l, p=0.042). Despite this, there were no significant differences between the two groups in maternal hemoglobin levels on the first postpartum day or in the incidence of maternal bleeding complications, including postpartum hemorrhage (PPH), blood transfusion, and therapeutic hysterectomy. Notably, the DCC group demonstrated significantly higher levels of neonatal admission hemoglobin, hemoglobin on day 3, and hematocrit on day 3. Furthermore, DCC was associated with a substantial reduction in the risk of neonatal anemia (adjusted OR, 0.244 [95% CI: 0.105-0.566, p<0.001) and intraventricular hemorrhage (aOR, 0.488 [95% CI, 0.157-0.628], p=0.006). The DCC group exhibited a significantly higher incidence of hyperbilirubinemia (aOR, 2.735 [95% CI, 1.735-4.310], p<0.001). However, there was no significant difference in the rate of phototherapy between the DCC and ECC groups (aOR, 0.731 [95% CI, 0.449-1.028], p=0.108). Compared with ECC, DCC did not result in an increased risk of maternal bleeding complications, neonatal mortality or severe adverse neonatal outcomes in twin pregnancies during cesarean delivery. Although DCC elevated neonatal hemoglobin levels and increased the incidence of hyperbilirubinemia, the rate of phototherapy did not increase. Notably, DCC was linked to a significantly reduced risk of neonatal anemia and intraventricular hemorrhage in cesarean-delivered twins.

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..

This study evaluates oral azithromycin's effectiveness in reducing intrapartum and puerperal infection rates in term pregnant women undergoing labor induction to guide antibiotic prophylaxis. This single-center randomized controlled trial enrolled 472 women with term singleton pregnancies undergoing labor induction. The participants were randomly allocated to receive either 2 g of oral azithromycin (n = 236) or no treatment (n = 236). The primary outcome was the overall perinatal infection rate (which includes both intrapartum and/or puerperal infections). Secondary outcomes included maternal and neonatal complications, mode of delivery, and safety parameters. Results analysis adopted an intention-to-treat approach. The overall perinatal infection rate did not differ significantly between the azithromycin group (16.1%) and the control group (16.9%) (absolute risk difference [ARD] = -0.85%, relative risk [RR] = 0.950, 95% confidence interval 0.633-1.425; P = 0.804). Similarly, the incidence of neonatal infectious diseases showed no significant difference between the two groups (2.5% vs 5.1%, P = 0.149). Both groups had comparable outcomes in mode of delivery, maternal-neonatal complications (epidural analgesia, postpartum hemorrhage, and pre- and post-delivery antibiotic use), total labor duration, neonatal hypoglycemia, neonatal intensive care unit admission, and neonatal antibiotic administration. Maternal outcomes did not differ significantly between groups, although 3.4% (8/236) of women in the azithromycin group reported gastrointestinal symptoms during labor, with a total adverse event rate of 3.8% (9/236, including one case of dizziness). The use of an additional 2 g azithromycin provides no additional benefit in reducing the overall risk of maternal infection and perinatal infection in an already intensive antibiotic prophylactic and well-resourced setting. This study was registered in the Chinese Clinical Trial Registry, registration number ChiCTR2300077629, November 14, 2023 (https://www.chictr.org.cn/showprojEN.html).

The New York State Safe Motherhood Initiative, a statewide quality-improvement effort, developed a bundle to optimize management of obstetric hemorrhage that was then disseminated and implemented by many hospitals in New York State. The purpose of this study was to evaluate trends in statewide outcomes related to postpartum hemorrhage (PPH) before, during, and after Safe Motherhood Initiative obstetric hemorrhage bundle implementation. Delivery hospitalizations in the 2007-2022 New York State Inpatient Database were analyzed for this repeated ecologic cross-sectional analysis that evaluated outcomes before and after implementation of the Safe Motherhood Initiative obstetric hemorrhage bundle from 2013 to 2015. The New York State Inpatient Database includes discharge data for all inpatient acute care hospitalizations in New York. Trends analysis of PPH diagnoses among all delivery hospitalizations over the study period was first performed. Then, among deliveries complicated by PPH, the rate of the following adverse outcomes was determined by year: 1) transfusion, 2) nontransfusion severe maternal morbidity (SMM), 3) disseminated intravascular coagulation (DIC), and 4) hysterectomy. Analyses were performed with joinpoint regression to determine the average annual percent change (AAPC). Adjusted logistic regression models were additionally performed for each of the adverse outcomes. Among 3,563,885 delivery hospitalizations, PPH increased continuously from 22 per 1,000 in 2007 to 59 per 1,000 in 2022 (AAPC 6.9%, 95% CI, 6.5-7.5%). In joinpoint analysis, transfusion among delivering patients with PPH increased from 192 per 1,000 in 2007 to 212 per 1,000 in 2013 (AAPC 2.1%, 95% CI, 0.6-6.6%) but then decreased to 174 per 1,000 in 2016 (AAPC -6.8%, 95% CI, -9.5% to -2.1%) before increasing again to 212 per 1,000 in 2022 (AAPC 2.8%, 95% CI, 1.2-8.1%). Severe maternal morbidity increased from 88 per 1,000 in 2007 to 122 per 1,000 in 2014 (AAPC 2.8%, 95% CI, 0.7-7.6%) before decreasing to 76 per 1,000 in 2017 (AAPC -16.3%, 95% CI, -20.8% to -8.4%) before rising again to 88 per 1,000 in 2022 (AAPC 4.4%, 95% CI, 0.1-18.5%). Disseminated intravascular coagulation increased from 54 per 1,000 in 2007 to 90 per 1,000 in 2014 (AAPC 4.5%, 95% CI, 1.3-12.6%), decreased to 53 per 1,000 in 2017 (AAPC -19.3%, 95% CI, -25.3% to -8.9%), and increased without a significant statistical association to 88 per 1,000 in 2022 (AAPC 4.2%, 95% CI, -2.0% to 24.5%). Hysterectomy decreased significantly from 26 per 1,000 in 2013 to 9 per 1,000 in 2022 (AAPC -10.2%, 95% CI, -14.3% to -8.7%). In logistic regression analysis, adjusted odds of severe morbidity from 2016 to 2022 were decreased compared with 2007 after accounting for patient- and hospital-level factors. The initiation of the New York Safe Motherhood Initiative obstetric hemorrhage bundle coincided with decreased risk for a range of adverse outcomes among deliveries complicated by PPH. Decreases in risk continued for approximately 3-4 years after initiation of the program for SMM, DIC, and transfusion. In comparison, hysterectomy decreased continuously until the end of the study period. Case mix and worsening comorbidity may have accounted for later study trends given that adjusted regression models for SMM demonstrated decreased odds of peripartum hysterectomy over the later portion of the study.

Rotational thromboelastometry (ROTEM) provides rapid, point-of-care coagulation data. However, the specific effect of its use for coagulopathy management on blood component transfusions during severe postpartum hemorrhage remains undetermined. We aimed to assess whether the use of ROTEM was associated with reduced administration of hemostatic blood products and blood transfusions in women with postpartum hemorrhage ≥1000 mL. In this single-center retrospective pre-post matched study, administration of hemostatic blood products and packed red blood cells was compared in two groups of adult patients with postpartum hemorrhage ≥1000 mL. The Control group consisted of patients managed empirically or based on laboratory results between 2016 and 2018. The ROTEM group consisted of patients managed using a ROTEM-guided coagulopathy protocol between 2021 and 2023. Exact matching was applied for qualitative variables, and propensity score matching was used for quantitative variables. A 1:1 matching procedure was performed using 14 confounders. Odds ratios were estimated using conditional logistic regression. After matching, 102 patients were included in each group. ROTEM use was associated with significantly lower transfusion rates of any hemostatic blood product (25% vs. 38%; OR: 0.46 [95% CI: 0.22 to 0.94]), fibrinogen concentrates (25% vs. 37%; OR: 0.48 [95% CI: 0.23-0.98]), fresh frozen plasma (3% vs. 17%; OR: 0.13 [95% CI: 0.03-0.54], and packed red blood cells (29% vs. 49%; OR: 0.38 [95% CI: 0.19-0.73]). The use of ROTEM to manage hemostatic impairment in postpartum hemorrhage ≥1000 mL was associated with a significant reduction in the transfusion of hemostatic blood products and red blood cells.

IntroductionDespite global efforts to reduce maternal mortality, progress has stalled, particularly in sub-Saharan Africa, where the maternal mortality ratio remains high. This study aims to assess in-facility maternal mortality, maternal and foetal complications, and stillbirths in referral hospitals at different levels of the health system in Guinea.MethodsThis was a cross-sectional study conducted at three urban referral hospitals in Guinea at the district (Hôpital de district de Forécariah or HD), regional (Hôpital Régional de Mamou or HR) and national (Hôpital National Ignace Deen or HN) levels from May 2021 to April 2023. Key indicators assessed included in-facility maternal mortality ratio (IMMR), maternal and foetal complication rates and stillbirth rates.ResultsA total of 25 235 women were admitted to the three hospitals over the 24-month period for maternal indications. The highest IMMR was recorded at HN (1264 per 100 000 live births), followed by HD (376) and HR (245). Postpartum haemorrhage was the leading cause of maternal death, accounting for 37% of cases at HR and 58% at HN. At HN, the other frequent causes included anaemia, postpartum sepsis and pre-eclampsia/eclampsia, whereas at HR, obstructed labour, anaemia and pre-eclampsia/eclampsia were frequently reported. Maternal and foetal complications were observed in 23% of deliveries at HD, 24% at HR and 40% at HN. Caesarean section rates were 35% at HD, 29% at HR and 54% at HN. Stillbirth rates ranged from 77 to 103 per 1 000 across the hospitals, with fresh stillbirths accounting for 40–50% of cases.ConclusionsThis study highlights the pressing need to strengthen emergency obstetric care and referral systems at district, regional and national hospitals. Investing in healthcare workers' capacity, ensuring timely transport for referrals and enhancing data quality systems for evidence-based decision-making are essential steps to reduce maternal and perinatal mortality and to achieve the sustainable development goals.

Obstetric care demands clinical reasoning, technical skills and timely decisions. Persistent training gaps highlight the need for strategies that integrate theory and practice. Educational technologies, especially virtual clinical simulation, offer safe, realistic environments for skill development. Thus, this study aimed to validate a virtual simulation prototype for teaching natural childbirth care. This methodological study, conducted between May 2021 and June 2022, involved three stages: construction of the storyboard of a virtual simulation prototype including two clinical scenarios (normal labor and postpartum hemorrhage); content validation by 26 experts who assessed the scenarios and storyboard interfaces using the Suitability Assessment of Materials (SAM), analysis based on the Agreement Index (AI); and appearance validation by 16 obstetric nursing residents using the Instrument for Validation of the Appearance of Educational Technologies in Health (IVAETH). Ethical approval was obtained, and all participants provided informed consent. The design and storyboard of the simulator demonstrated adequacy for its intended educational purpose. The sample, composed of 26 nurse specialists with experience in technology validation, positively validated all screens of the constructed storyboard, with an agreement index greater than 0.90 in the six evaluation domains (Content; Language appropriate for the population; Graphic illustrations, lists, tables; Layout and typography; Learning and motivation; and Cultural adaptation). Sixteen obstetric nursing residents, predominantly at the State University of Ceará, participated in this study. The evaluation of the domains for appearance validation yielded an average agreement index greater than 0.80 among residents. The storyboard developed for virtual reality simulation scenarios in childbirth care demonstrated high levels of agreement in both content and appearance validation, indicating its adequacy as an educational tool for obstetric nursing training. The validated structure provides a foundation for the future development of the Birth Now virtual simulator to support clinical decision-making in childbirth care.

ObjectiveTo investigate whether prophylactic tranexamic acid reduces the incidence of postpartum haemorrhage in women with placenta praevia compared with placebo.DesignRandomised, double blind, placebo controlled, phase 3 study.Setting24 maternity units across China between July 2023 and March 2025.Participants1732 women with placenta praevia undergoing caesarean delivery.InterventionsParticipants were randomly (1:1) assigned to receive prophylactic oxytocin and either tranexamic acid (1 g in 10 mL) or placebo (10 mL normal saline) diluted in 40 mL normal saline intravenously over 10 minutes, initiated within five minutes of umbilical cord clamping.Main outcome measuresThe primary outcome was postpartum haemorrhage, defined as calculated estimated blood loss ≥1000 mL or as red cell transfusion within two days after delivery. Serious adverse events included thromboembolic events, seizures, acute kidney or liver injury, and maternal death.ResultsOf 1732 women with placenta praevia who were randomised, 38 were excluded because they withdrew consent or were determined to be ineligible after randomisation. Primary outcome data were available for 99.8% (1691/1694) of the remaining women. Placenta accreta spectrum was diagnosed in 303 participants (17.9%). The primary outcome occurred in 29.7% (251/845) of the tranexamic acid group and 35.1% (297/846) of the placebo group (relative risk 0.85, 95.2% confidence interval (CI) 0.75 to 0.96; P=0.01). The rates of serious adverse events were similar between the tranexamic acid group and placebo group (0.5% (4 of 837) v 0.5% (4 of 845); relative risk 1.01, 95% CI 0.25 to 4.00).ConclusionsIn women with placenta praevia who underwent caesarean delivery and received prophylactic oxytocin, treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage, with no signal of increased serious adverse events.Trial registrationClinicalTrials.gov NCT05811676.

Pregnancy, delivery, and neonatal outcomes in women with uterine fibroids carrying singleton vs. multiple gestations: A retrospective population database cohort study.

To quantify obstetric outcomes after prior myomectomy in a tertiary center and to explore whether operative and clinical characteristics are associated with uterine rupture. Single-center retrospective cohort of deliveries following laparotomic or laparoscopic myomectomy between August 2015 and January 2023. We extracted demographic, surgical, and obstetric data from electronic records, and analyzed only the first consecutive post-myomectomy pregnancy per patient. Sixty-three women delivered after prior myomectomy. 75.5% underwent laparotomic myomectomy and the remainder laparoscopic. The mean largest myoma diameter was 9.6 ± 3.4cm; 66.7% were intramural. Uterine cavity entry occurred in 30.4%. Trial of labor after myomectomy was attempted in four patients (6.3%) and was successful in three. Two patients had placenta accreta spectrum (3.2%), and two required transfusions for postpartum hemorrhage. One full-thickness uterine rupture was identified incidentally at a planned elective cesarean at 37.4weeks (1/63; 1.6%) in an asymptomatic patient not in labor. A short myomectomy-to-pregnancy interval showed an association with rupture: < 3months (OR 103.0, 95% CI 2.85-3728.2; p = 0.007) and < 6months (OR 25.9, 95% CI 1.94-716.8; p = 0.037). No other variables reached statistical significance, although the analysis was underpowered to assess additional predictors. Uterine rupture after myomectomy was rare (1.6%) in our cohort and was associated with a short myomectomy-to-pregnancy interval. However, as this association is based on a single event, it should be interpreted with caution and considered hypothesis-generating. Despite the low absolute risk, and consistent with literature supporting TOLAM in selected patients, TOLAM was markedly underutilized in our center, highlighting a practice gap that may be addressed through more standardized counseling and delivery planning in tertiary settings.

Factor VII (FVII) Padua is a rare inherited disorder caused by a missense variant in the F7 gene (Arg364Gln), resulting in variable FVII activity depending on the thromboplastin source used in assays. Although often linked to a hypercoagulable state, critical gaps remain in understanding its diagnosis, clinical manifestations, and geographic distribution.Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted through February 2026 to identify studies reporting FVII Padua. Data on demographics, laboratory findings, and bleeding or thrombotic events were extracted from eligible publications.Thirty-six studies comprising 75 patients were identified. Most cases originated from Italy (22.6%), Iran (20%), the USA (17.3%), France (12%), and Brazil (9.3%). Ages ranged from 5 to 79 years. Sex information was available for 50 patients, of whom 27 (54%) were female and 23 (46%) were male. Prolonged prothrombin time and markedly reduced FVII activity using rabbit-brain thromboplastins were key diagnostic features, while human or recombinant thromboplastins showed milder reductions. Nearly half of the patients (n = 28; 49%) were asymptomatic; however, some experienced severe bleeding, including postpartum hemorrhage (n = 1; 1.7%) and gastrointestinal bleeding (GIB) (n = 3; ~5%). Thrombotic events were reported in six patients out of 13 (46%), including deep vein thrombosis (DVT) in two patients (33.3%) and pulmonary embolism (PE) in one patient (16.6%).This study demonstrates the global distribution and clinical heterogeneity of FVII Padua, emphasizing the need for thromboplastin-specific diagnostic evaluation and individualized management. Further research is essential to address existing diagnostic and therapeutic gaps.

Membranous dysmenorrhea, characterized by the expulsion of intact endometrial tissue rather than gradual dissolution during menstruation, occasionally presents as a decidual cast-a complete triangular mold of the uterine cavity. This poorly understood condition is likely underdiagnosed. This study maps and describes the existing English literature on membranous dysmenorrhea and decidual cast expulsion, focusing on clinical presentation, etiology, and management. A scoping review was conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, EMBASE, Web of Science, and CINAHL were searched using the terms "membranous dysmenorrhea," or "membranacea dysmenorrhea," or "decidual cast," limited to English-language publications. The final search was performed in February 2026. Google Scholar and manual screening of references supplemented the search. English-language full text publications reporting on membranous dysmenorrhea or decidual cast expulsion were included, encompassing case reports, case series, and observational studies. Data extracted included publication type, geographical origin, patient demographics, clinical features, and management approaches. Thematic analysis was performed to identify key patterns. One hundred and thirteen publications met inclusion criteria, including 86 case reports/series describing 121 individual cases, plus 42 additional cases from a single-author report. Patient ages ranged from 9 to 53 years. Most cases involved vaginal passage of tissue, with or without pain. Early reports noted spontaneous and recurrent episodes, while recent cases were often sporadic and involved hormonal treatments, particularly progestins. Additional associations were infection, ectopic pregnancy, pregnancy in uterus bicornis/didelphys, and postpartum hemorrhage. Proposed etiologies include hormonal influences (endogenous/exogenous progesterone), endometritis, or normal menstruation variants. Most cases resolved without intervention. Some required dilatation and evacuation of the uterine cavity. Membranous dysmenorrhea and decidual cast expulsion are benign phenomena that might cause diagnostic confusion and unnecessary interventions. Increased clinical awareness is essential for appropriate counseling and to distinguish this condition from early pregnancy loss. Hormonal contraceptives might act as both triggers and therapeutic agents. Further research beyond case reports is needed.