Obstetric Risk Research Articles

Risk of severe influenza infection in women with a history of pregnancy complications: A longitudinal cohort study.

Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later. We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy. A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30-1.69), preeclampsia (HR 1.45, 95% CI 1.28-1.65), placental abruption (HR 1.36, 95% CI 1.12-1.66), preterm birth (HR 1.40, 95% CI 1.27-1.55), cesarean section (HR 1.22, 95% CI 1.13-1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22-1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care. Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization.

Sociodemographic Profile Of Syphilis In Pregnant Women In The Municipality Of Norte Do Tocantins

Objective: The aim of this study was to evaluate the sociodemographic profile of syphilis in pregnant women from 2015-2021 in Araguatins in the state of Tocantins. Methodology: The research is an epidemiological study of a quantitative and exploratory-descriptive nature. Regarding the sociodemographic profile of these pregnant women, it was pointed out that they have a low level of schooling, a higher age range between 13-23 years, and (82.5%) self-declared as brown, such information suggests a group of greater social vulnerability. Results: The occurrence of syphilis during pregnancy is directly related to several factors, including color, low level of education, unfavorable socioeconomic conditions, history of obstetric risk, late start of prenatal care and an insufficient number of appointments. Conclusion: This study emphasizes the urgent need to review the procedures adopted and highlights the importance of health professionals taking greater responsibility for a problem that is largely preventable

The lifetime risk of maternal near miss morbidity in Asia, Africa, the Middle East, and Latin America: a cross-country systematic analysis

Life-threatening maternal near miss (MNM) morbidity can have long-term consequences for the physical, psychological, sexual, social, and economic wellbeing of female individuals. The lifetime risk of MNM (LTR-MNM) quantifies the probability that a female individual aged 15 years will have an MNM before age 50 years, given current mortality and fertility rates. We compare the LTR-MNM globally to reveal inequities in the cumulative burden of severe maternal morbidity across the reproductive life course. We estimated the LTR-MNM for 40 countries with multifacility, regional, or national data on the prevalence of MNM morbidity measured using WHO or modified WHO criteria of organ dysfunction from 2010 onwards (Central and Southern Asia=6, Eastern and Southeastern Asia=9, Latin America and the Caribbean=10, Northern Africa and Western Asia=2, sub-Saharan Africa=13). We also calculated the lifetime risk of severe maternal outcome (LTR-SMO) as the lifetime risk of maternal death or MNM. The LTR-MNM ranges from a 1 in 269 risk in Viet Nam (2010) to 1 in 6 in Guatemala (2016), whereas the LTR-SMO ranges from a 1 in 201 risk in Malaysia (2014) to 1 in 5 in Guatemala (2016). The LTR-MNM is a 1 in 20 risk or higher in nine countries, seven of which are in sub-Saharan Africa. The LTR-SMO is a 1 in 20 risk or higher in 11 countries, eight of which are in sub-Saharan Africa. The relative contribution of the LTR-MNM to the LTR-SMO ranges from 42% in Angola to 99% in Japan. There exist substantial global and regional disparities in the cumulative burden of severe maternal morbidity across the reproductive life course. The LTR-MNM is an important indicator to highlight the magnitude of inequalities in MNM morbidity, once accounting for obstetric risk, fertility rates, and mortality rates. The LTR-SMO can be used to highlight variation in the relative importance of morbidity to the overall burden of maternal ill-health across the female reproductive life course, given countries' stage in the obstetric transition. Both the LTR-MNM and LTR-SMO can serve as important indicators to advocate for further global commitment to end preventable maternal morbidity and mortality. UK Economic and Social Research Council, EU Horizon 2020 Marie Curie Fellowship, and Leverhulme Trust Large Centre Grant.

Novel risk factors associated with retained placenta after vaginal birth.

To evaluate maternal and obstetric risk factors associated with retained placenta following singleton live vaginal births. We conducted a retrospective cohort study of women diagnosed with retained placenta after singleton live vaginal birth at or after 24 weeks of gestation, compared in a 1:2 ratio with women who had uncomplicated vaginal deliveries. The study and control groups were matched for maternal age, gestational age, and parity. Multivariate regression analysis assessed potential risk factors related to retained placenta. In all, 15,260 women who delivered at our medical center(both vaginal and non-vaginal)between 2015 and 2022, 170 (1.1%) were diagnosed with retained placenta. Ninety-nine women (0.65%) who met the inclusion criteria were matched with 198 controls (1.3%). Multivariate logistic regression identified potential risk factors not previously described for retained placenta, including in vitro fertilization (OR 3.8, 95% CI 1.3-11.7, P = 00.018), large-for-gestational-age fetuses (OR 28.2, 95% CI 5.4-148.5, P = 00.029), and endometriosis (OR 8.2, 95% CI 0.92-20, P = 00.024). Additional risk factors included pre-eclampsia, labor induction, vacuum-assisted delivery, and prolonged second-stage labor. This study identifies critical risk factors for retained placenta, highlighting the importance of early identification to improve maternal and neonatal outcomes.

Study protocol of a breathing and relaxation intervention included in antenatal education: A randomised controlled trial (BreLax study).

Antenatal education is part of antenatal care in many countries. Physical and mental preparation for childbirth and information on pain management are considered key elements of antenatal education classes. Evidence suggests that women who participate in antenatal education classes appear to benefit in terms of self-efficacy and childbirth experience. In particular, women with increased fear of childbirth benefit from trained breathing and relaxation techniques in antenatal education. However, little is known about the effect of breathing and relaxation techniques on the outcomes of healthy pregnant women without fear of childbirth or who do not have medical or obstetric risks, or on neonatal outcomes. The aim of this study is to test whether including a breathing and relaxation technique in an antenatal education class will improve self-efficacy towards birth compared to a standard antenatal education class. The study will be a two-armed randomised controlled trial (RCT). Healthy pregnant women between the 12th and 30th week of gestation with singleton low-risk pregnancies and who are receiving routine antenatal care will be recruited in a hospital in Switzerland. All women included will attend an 8-hour antenatal education class. The intervention group will additionally practise a breathing and relaxation technique, receive a handbook to guide their exercise practice at home, and be provided with access to an online brochure with video and audio recordings for guidance. Data on maternal and neonatal outcomes will be collected after recruitment, in the 37th week of pregnancy, and two to four weeks postpartum. The effectiveness of including a breathing and relaxation technique in antenatal education classes on women's self-efficacy is discussed as a means to improving women's pregnancy and childbirth outcomes. NCT06003946, SNCTP000005672.

Modern ideas about the predictions of postpartum hemorrhage

Postpartum hemorrhage is currently a pressing problem. Its increasing incidence over time is observed not only in developing countries but also in countries with high levels of income and resources that significantly contribute to the development and functioning of the health system, which is the cause of scientific debate worldwide. The risk factors of postpartum hemorrhage include low hemoglobin level before birth, older maternal age, first birth, prolonged duration of the first and second stages of labor, high birth weight of the newborn, abnormal placentation, surgical vaginal birth, cesarean section, episiotomy, and placental defects. This review outlines the main risk factors of postpartum hemorrhage, displays new data on the relationship between types of assisted reproductive technologies and postpartum hemorrhage, and discusses prospects for research regarding the problem. A link between assisted reproductive technologies and postpartum hemorrhage elucidates the increase in the incidence of postpartum hemorrhage in developed countries. It is crucial to further research on obstetric risks following the use of assisted reproductive technologies and identify additional risk categories for complications to provide quality medical care and reduce maternal and perinatal losses.

Migraine in antiphospholipid syndrome and hereditary thrombophilia: pregnancy-related clinical and diagnostic features and therapeutic issues

Introduction. Migraine is one of the most common primary headaches and a risk factor for cardiovascular and cerebrovascular diseases. Antiphospholipid syndrome (APS) and hereditary thrombophilia (HT) causing pathological pregnancy are highly associated with migraine. Timely migraine recognition related to APS and HT facilitates earlier initiation of thrombophilia pathogenetic therapy and prevention of potential complications.Aim: to analyze the literature data on migraine clinical and diagnostic features in APS and HT as well as pregnancy-related therapeutic issues.Materials and Methods. A search for scientific literature was conducted in electronic databases including PubMed, Google Scholar, eLibrary from 2004 until May 2024. The search methodological basis included the presence of the following keywords and their combinations in Russian and English: "migraine", "antiphospholipid syndrome", "thrombophilia", "migraine and pregnancy", "migraine and thrombophilia", "migraine and cardiovascular diseases". As a result, a total of 184 publications were identified. Next, 62 articles were included in the review.Results. At the current stage, neurologists have no means to diagnose migraine in APS and HT based on headache-intrinsic characteristics. Pregnancy increases a risk of thrombotic complications. A migraine observed in patient's history should be crucial while assessing pregnancy-related obstetric risk. While diagnosing migraine, neurologists need to examine patient obstetric history. The data on most effective and safe therapy for pregnancy-related migraine attacks remain scarce.Conclusion. The frequent association between APS and HT with migraine, the lack of clear migraine clinical features in thrombophilia, patients’ reproductive age, and the high risk of thrombotic complications necessitate collaboration between neurologists and obstetricians-gynecologists for timely diagnostics and management of such patients. The impact of various types of antithrombotic therapy on migraine course requires further clarification. It is promising to conduct studies able to determine of whether migraine attack prevention can avoid adverse pregnancy outcomes in women with former migraine.

Perinatal mortality among term births: Informing decisions about singleton early term births in Western Australia.

To minimise the risk of perinatal mortality, clinicians and expectant mothers must understand the risks and benefits associated with continuing the pregnancy. Report the gestation-specific risk of perinatal mortality at term. Population-based cohort study using linked health data to identify all singleton births at gestations 37-41 weeks, in Western Australia (WA) from 2009 to 2019. Lifetable analysis was used to combine the risk of each type of perinatal mortality and calculate the cumulative risk of perinatal mortality, termed the perinatal risk index (PRI). Rates of antepartum and intrapartum stillbirth and neonatal death, as well as the PRI, were examined for each gestational week at term by non-Aboriginal and Aboriginal ethnicity. For non-Aboriginal women, rates were also examined by time-period (pre- vs. post-WA Preterm Birth Prevention Initiative (the Initiative) rollout), primiparity, and obstetric risk. There were 332,084 singleton term births, including 60 perinatal deaths to Aboriginal mothers (3.2 deaths per 1000 births to Aboriginal mothers) and 399 perinatal deaths to non-Aboriginal mothers (1.3 deaths per 1000 births to non-Aboriginal mothers). For non-Aboriginal women, the PRI was at its lowest (PRI 0.80, 95% CI 0.61, 1.00) at 39 weeks gestation. For Aboriginal women, it was at its lowest at 38 weeks (PRI 2.43, 95% CI 0.48, 4.39) with similar risk at 39 weeks (PRI 2.68, 95% CI 1.22, 4.14). The PRI increased steadily after 39 weeks gestation. The risk of perinatal mortality was higher among Aboriginal women. The gestation-specific perinatal mortality rates were similar by the time-period, primiparity and obstetric risk. The gestational ages at term associated with the lowest risk of perinatal mortality reinforce that the recommendation not to deliver before 39 weeks without medical indication is applicable to both Aboriginal and non-Aboriginal women giving birth in WA. There was no increase in the perinatal mortality rate associated with the introduction of the Initiative.

Impact of vaginism on mode of delivery and obstetrical outcomes

IntroductionAccording to ICD 10, vaginism is defined as the presence of spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening. Intromission is impossible or painful. Vaginism, whose prevalence is estimated at 1%, is often diagnosed during pregnancy follow-up, when clinical examination is difficult or impossible. However, few studies report obstetrical complications and pregnancy outcomes associated with this pathology. ObjectiveEvaluate the impact of vaginism on mode of delivery and obstetrical complications. Materials and methodsComparative, monocentric, retrospective study at the Montreuil maternity hospital between January 2019 and January 2024 that included all singleton deliveries in cephalic presentation at term. Vaginism was defined as an involuntary contraction of the pelvic muscles that made clinical examination during pregnancy impossible. Mode of delivery (caesarean section during labour, operative delivery, spontaneous vaginal delivery) and obstetric complications (episiotomy, OASIS, complex tear, Postpartum haemorrhage (PPH) due to tear) were compared between patients with vaginism and a control group, in univariate analysis and multivariate logistic regression with adjustment for maternal age, BMI, maternal origin, gestational age, high obstetrical and medical risk level, diabetes with or without insulin use, pregnancy complications, Robson group and birthweight. A propensity score adjustment with matching 1 case to 3 controls was conducted. ResultsDuring the study period, 13,469 patients were included, among which 440 patients had vaginism. In univariate analysis, patients with vaginism had a higher rate of caesarean section (16,8% versus 9,4%, p < 0.001), operative delivery (29,3% versus 13,3%, p < 0.001), episiotomy (12,5% versus 5.3 %, p < 0.001), OASIS (3.4 % versus 1.0 %, p < 0.001), complex tear (17,5% versus 7,7%) and PPH due to tear (2,5% versus 1,1%, p = 0,009).After adjustment, vaginism appeared to be an independant risk factor for cesarean section with a psaOR of 1.38 [1.02–1.85], operative delivery psaOR 2.39 [1.83–3,10], OASIS psaOR 2,19 [1.10–4,27], and complex tear psaOR 1,39 [1,02–1,87] ConclusionVaginism appears to be an independent risk factor for cesarean section, operative delivery, OASIS, and complex tear. Further studies should evaluate the impact of early and appropriate follow-up during pregnancy on adverse obstetrical outcomes.

The anthropology of obstetrics and obstetricians: The practice, maintenance, and reproduction of a biomedical profession By RobbieDavis‐Floyd and AshishPremkumar (Eds.), New York: Berghahn Series. Three volume series.Volume 1 – Obstetricians speak: On training, practice, fear, and transformation. 2023. 345 pp.Volume 2 – Cognition, risk, and responsibility in obstetrics: Anthropological analyses and critiques of obstetricians’ practices. 2023. 334 pp.Volume 3 –

The anthropology of obstetrics and obstetricians: The practice, maintenance, and reproduction of a biomedical profession By RobbieDavis‐Floyd and AshishPremkumar (Eds.), New York: Berghahn Series. Three volume series.Volume 1 – Obstetricians speak: On training, practice, fear, and transformation. 2023. 345 pp.Volume 2 – Cognition, risk, and responsibility in obstetrics: Anthropological analyses and critiques of obstetricians’ practices. 2023. 334 pp.Volume 3 –

Fertility-sparing treatment with conization versus radical hysterectomy in patients with early-stage cervical cancer: inverse propensity score weighted analysis

ObjectiveTo report 20 years of experience with fertility-sparing surgery for patients with early-stage cervical cancer, comparing the oncological outcomes with outcomes for those who underwent a radical hysterectomy.MethodsPatients with pre-operative...

Relation Between Initiation of Breastfeeding Success and Postpartum Depression

ObjectivesThis study was designed to assess the effect of initiation of breastfeeding success on postpartum depression (PPD) among women who gave birth in Quebec. MethodsSecondary analysis of the “Quality of Care, Obstetrics Risk Management, and Mode of Delivery” trial (QUARISMA trial), conducted in Quebec from 1 April 2008 to 31 October 2011 to reduce rates of cesarean delivery in Quebec. Inclusion criteria: all women ≥18 years old who gave birth at the hospital of a single baby ≥370 weeks of gestation. Logistic regression was performed to investigate the impact of initiation of breastfeeding success on PPD rates. Outcome was reported using adjusted ORs with 95% CIs. ResultsA total of 151 708 women (21 525 women with unsuccessful initiation of breastfeeding and 130 183 women with successful initiation of breastfeeding) were selected to participate in this study. We observed a significant association between initiation of breastfeeding success and a lower rate of PPD (0.16% vs. 0.29%) (OR 0.57; 95% CI 0.41–0.79, P < 0.001). ConclusionsInitiation of breastfeeding success is significantly associated with a lower risk of PPD.

Obstetric Perineal Tears, Birth Characteristics and the Association with Urinary Incontinence Among Primiparous Women 12 Months Postpartum: A Prospective Cohort Study.

Postpartumurinary incontinence (UI)is common and aconcern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women. A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI. A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92-4.50; episiotomy: RR 2.22, 95% CI 0.99-4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18-6.28). The same was found for SUI, but with wider confidence intervals. A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.

Trends and determinants of the use of episiotomy in a prospective population-based registry from central India

BackgroundFindings from research and recommendations from the World Health Organization favor restrictive use of episiotomy, but whether this guidance is being followed in India, and factors associated with its use, are not known. This study sought to document trends in use of episiotomy over a five-year period (2014–2018); to examine its relationship to maternal, pregnancy, and health-system characteristics; and to investigate its association with other obstetric interventions.MethodsWe conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined type of birth and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models.ResultsDuring the five-year interval, the rate of episiotomy in vaginal birth rose from 13 to 31% despite a decline in assisted vaginal birth. Associations with episiotomy were found for the following factors: prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center). After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08–1.12; p = 0.002]. We found an association between episiotomy and several other obstetric interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.23, 95% CI 3.12–5.73; p = 0.001).ConclusionsEpisiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the birthing provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance.Trial RegistrationThe study was registered at ClinicalTrials.gov under reference number NCT01073475.

Maternal Streptococcus agalactiae colonization in Europe: data from the multi-center DEVANI study.

Despite national guidelines and use of intrapartum antibiotic prophylaxis (IAP), Streptococcus agalactiae (group B streptococci (GBS)) is still a leading cause of morbidity and mortality in newborns in Europe and the United States. The European DEVANI (Design of a Vaccine Against Neonatal Infections) program assessed the neonatal GBS infection burden in Europe, the clinical characteristics of colonized women and microbiological data of GBS strains in colonized women and their infants with early-onset disease (EOD). Overall, 1083 pregnant women with a GBS-positive culture result from eight European countries were included in the study. Clinical obstetrical information was collected by a standardized questionnaire. GBS strains were characterized by serological and molecular methods. Among GBS carriers included in this study after testing positive for GBS by vaginal or recto-vaginal sampling, 13.4% had at least one additional obstetrical risk factor for EOD. The five most common capsular types (i.e., Ia, Ib, II, III and V) comprised ~ 93% of GBS carried. Of the colonized women, 77.8% received any IAP, and in 49.5% the IAP was considered appropriate. In our cohort, nine neonates presented with GBS early-onset disease (EOD) with significant regional heterogeneity. Screening methods and IAP rates need to be harmonized across Europe in order to reduce the rates of EOD. The epidemiological data from eight different European countries provides important information for the development of a successful GBS vaccine.

Principles of Obstetric Risk Management in Medical Care

&lt;p&gt;產科風險管理是一個系統性、持續性的過程，需要醫療機構全體成員的共同協作，也是臨床醫師在醫療工作中不可忽視的重要環節。通過對風險的識別、評估、控制及監測，持續的培訓教育和團隊合作，並建立醫療安全文化，希冀有效降低產科風險，提高產婦和新生兒的安全性。同時提高產婦的健康知識，定期產檢，加強心理健康教育，以及積極應對突發情況，都是減少產科風險的有效手段。未來，隨著科技和醫療技術的進步，產科風險管理將愈加科學化與系統化，也更加全面化和精緻化。而產科醫師亦應該持續關注和學習新興的風險管理知識，以應對不斷變化的醫療環境。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Obstetric risk management is a systematic and continual process that necessitates the collective collaboration of all members within medical institutions. It is also a critical component in clinical practice that clinicians cannot afford to overlook. Through the identification, assessment, control, and monitoring of risks; ongoing training and education, team collaboration; and the establishment of a culture of medical safety, obstetric risks may be effectively reduced and the safety of both mothers and newborns may be enhanced. Additionally, improving maternal health knowledge, ensuring regular prenatal check-ups, strengthening psychological health education, and proactively addressing emergencies are all effective strategies for minimizing obstetric risks. In the future, as technology and medical techniques advance, obstetric risk management is expected to become increasingly scientific and systematic as well as more comprehensive and refined. Obstetricians should, therefore, continuously stay informed about and learn new risk management knowledge to adapt to the constantly evolving medical environment.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Clinical Features Between Primary Obstetric Antiphospholipid Syndrome and Non-Criteria Obstetric Antiphospholipid Syndrome and Risk Factors of Adverse Pregnancy Outcomes: A Retrospective Study of 1006 Cases.

To compare the clinical characteristics and pregnancy outcomes between patients with primary obstetric antiphospholipid syndrome (OAPS) and those with primary non-criteria obstetric antiphospholipid syndrome (NC-OAPS), and to identify the risk factors of adverse pregnancy outcomes in both groups. A retrospective single-center study was performed in a university hospital of western China, including 141 patients with OAPS and 865 patients with NC-OAPS. The clinical characteristics, pregnancy complications, and obstetric outcomes of the cohorts were collected from the hospital system and were compared by univariable analysis, and the independent risk factors for adverse pregnancy outcomes (APO) were investigated by logistic regression analysis in these two populations. The OAPS patients had a significantly higher risk for stillbirths compared to the NC-OAPS patients, while the NC-OAPS group had a significantly higher risk for preterm birth and overall APO. Double aPL positivity, triple aPL positivity, and gestational hypertension were the independent risk factors for APO in OAPS patients, whereas two of the double aPL positivity subtypes, triple aPL positivity and placenta previa were independent risk factors for APO in NC-OAPS patients. This study identified different rates in different APOs among OAPS and NC-OAPS patients. Additionally, this study revealed different risk factors for the development of APO between the two populations. These findings indicated that OAPS and NC-OAPS are two distinct entities of the same disease, providing new insights into the individualized management for patients with OAPS and NC-OAPS.

A smartphone coaching program (“Bouge Grossesse”) improves daily physical activity in pregnant women

BackgroundPhysical activity has been shown to reduce obstetrical risks however pregnant women reduce their physical activity and sedentary behaviors increase. ObjectiveOur aim was to evaluate the impact of a smartphone application developed to increase daily physical activity in pregnant women. MethodsWe enrolled 250 pregnant women in a prospective randomized controlled study. These women were instructed to download either an intervention application called «Bouge Grossesse» (coaching program and a pedometer; n=125) or a Placebo application (pedometer only; n=125). Primary outcome was defined as a daily increase of 2000 steps/day between day 1 and day 90 or 10 000 steps/week between week 1 and week 12. Data was analyzed with intention to treat. Secondary outcomes were the number of steps at week 12 and the evolution of quality of life measured by WHO score, EIFEL score and SPIEGEL scale, and on maternal and fetal outcomes. ResultsPatients were enrolled between August 2017 and February 2019. They were retrospectively registered after September 2018. We found a significant difference in the primary outcome between the two groups in favor of the intervention group (22.4% success vs 3.2% in the control group, P<.001) but only 43 women in the intervention group (34.4%) and 16 women in the placebo group (12.8%) completed the 12-week coaching program. There were no significant differences in the SPIEGEL, EIFEL and WHO scores. The mean number of daily steps at week 12 was significantly higher in the intervention group (6900.0 vs 4371.9, P<.001). ConclusionThe mobile health intervention « Bouge Grossesse » significantly increased physical activity in pregnant women but we observed a high percentage of withdrawals from the 12-week program. Trial registrationThis clinical trial was registered under the number NCT03688087 ClinicalTrials.gov.

Pregnancy outcomes in patients with systemic lupus erythematosus compared to a high-risk tertiary cohort andtostandard population from the Austrian birth registry.

Women with systemic lupus erythematosus (SLE) have a higher risk for fetal and maternal complications. We aimed to investigate maternal and fetal complications in pregnant women with SLE compared to a high-risk pregnancy cohort (HR) from a tertiary university center and a standard-risk general population (SR) from the Austrian Birth Registry. In this retrospective data analysis, we compared the incidence of fetal/neonatal and maternal complications of pregnancies and deliveries of women with SLE to age, body mass index and delivery date-matched high-risk pregnancies from the same department, a progressive tertiary obstetric center and to a group of women, who represent pregnancies with standard obstetric risk from the Austrian Birth Registry. One hundred women with SLE were compared to 300 women with high-risk pregnancies and 207 039 women with standard-risk pregnancies. The incidence of composite maternal complications (preeclampsia, Hemolysis, Elevated Liver enzymes and Low Platelets [HELLP] syndrome, pregnancy-related hypertension, gestational diabetes mellitus, maternal death, thromboembolic events) was significantly higher in the SLE as compared to the SR group (28% vs. 6.28% SLE vs. SR, p = 0.001). There was no difference between the SLE and the HR groups (28% vs. 29.6% SLE vs. HR group, p = 0.80). The incidence of composite fetal complications (preterm birth before 37 weeks of gestation, stillbirths, birthweight less than 2500 g, fetal growth restriction, large for gestational age, admission to neonatal intensive care unit, 5-min Apgar <7) was also higher in the SLE than in the SR group (55% vs. 25.54% SLE vs. SR p < 0.001) while the higher incidence of adverse fetal outcome was detected in the HR than in the SLE group (55% vs. 75% SLE vs. HR group, p = 0.0005). Although composite fetal risk is higher in the SLE group than in the general population, it is still significantly lower as compared to high-risk pregnant women at a tertiary obstetric center. Prepregnancy counseling of women with SLE should put fetal and maternal risk in perspective, not only in relation to healthy, low risk cohorts, but also compared to mixed HR populations.

Stimulation Therapy to Induce Mothers: Protocol for a Multicenter Randomized Controlled Trial.

More than 1 million women have their labor induced in the United States each year, and synthetic oxytocin infusion is the most common method used. However, compared to spontaneous labor, medical induction is resource intensive, has increased obstetric risks, and is associated with less successful breastfeeding. In contrast to the endogenous oxytocin hormone, which is released in a pulsatile fashion in the brain, synthetic oxytocin is continuously infused intravenously, resulting in important limitations related to efficacy, safety, and cost. Akin to spontaneous labor contractions, infant suckling of the breast nipple is known to stimulate the pulsatile release of endogenous oxytocin from the posterior pituitary gland. Nipple stimulation therapy via an electric breast pump similarly stimulates endogenous oxytocin release and may be a favorable inpatient method for patients undergoing labor induction. This study aims to examine whether inpatient nipple stimulation therapy is an efficacious labor induction method that increases the likelihood of spontaneous vaginal delivery and sustained breastfeeding and determine whether it is a cost-effective approach. This is a multicenter, pragmatic, open-label, parallel-group randomized controlled trial of nulliparous patients with singleton gestations ≥36 weeks undergoing labor induction. This trial compares inpatient nipple stimulation therapy via an electric breast pump versus immediate synthetic oxytocin infusion without nipple stimulation. This trial including 988 nulliparas will provide adequate statistical power to detect clinically meaningful differences in delivery mode and breast milk as the sole source of nutrition for newborns at hospital discharge or 72 hours after birth. The project received pilot funding in 2021 and full funding in 2023. Enrollment for this study began in November 2021 at a single site, and as of May 2024, recruitment is underway at 3 study sites. It is anticipated that enrollment will be completed by late 2026. Successful completion of this trial will provide rigorous data to determine whether inpatient nipple stimulation therapy with an electric breast pump can improve the way we induce labor and positively impact breastfeeding success and early infant nutrition through lactation. ClinicalTrials.gov NCT05079841; https://clinicaltrials.gov/study/NCT05079841. DERR1-10.2196/63463.