Risk Of Obstetric Complications Research Articles

Obstetrical Complications in Venezuelan Refugee and Migrant Women: Analysis of Ecuadorian National Hospital Discharge Data, 2018-2021.

An estimated 7.7million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018-2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group.

Sleep Quality in High-Risk Pregnancies: Mixed Methods Results from a Randomized Controlled Trial of a Mindfulness Training Intervention.

Objectives: Sleep difficulties in pregnancy are common and increase the risk for obstetric complications. Past research shows that mindfulness training (MT) is helpful for improving sleep in non-pregnant adults and may improve sleep during pregnancy. However, it is unknown if MT improves sleep among pregnant people at risk for obstetric complications. We examined the effects of MT on sleep quality in individuals at risk of developing hypertensive disorders of pregnancy. Methods: Twenty-nine participants (mean age, 32 ± 4 years; mean gestational age, 16 ± 3weeks) at risk for hypertensive disorders in pregnancy (HDP) were randomized to an 8-week phone-delivered MT intervention (n = 15) or treatment as usual (TAU; n = 14), designed to test MT feasibility and acceptability. As part of the study, participants completed the Pittsburgh Sleep Quality Index and participated in a semi-structured individual qualitative interview which queried for sleep changes over pregnancy. Results: Participants randomized to MT reported less daytime sleep dysfunction compared to TAU (F = 5.79, p = 0.03, ηp2 = 0.28). Qualitative data illustrated the common experiences of sleep disturbance across both study groups; however, MT participants reported an improved ability to initiate sleep and return to sleep using mindfulness skills. About half of the participants in the MT condition reported an improvement in overall sleep quality due to less interference related to anxiety and restlessness, while other MT participants reported no change in sleep quality. Conclusions: Results from this study confirm that pregnant individuals frequently encounter sleep challenges. Findings also suggest that MT may be a helpful tool in improving sleep quality among pregnant people at risk for obstetric complications.

Anthropometric Indicators of the Proportionality of the Physique of Girls and Boys Living in the Moscow Region

Anthropometric data provide a qualitative and quantitative assessment of the health status of the population. Typically, they are used in clinical practice to assess general health, nutritional adequacy, growth and development of the body. The aim is to conduct a comparative analysis of anthropometric indicators and proportionality of the physique of boys and girls living in Moscow and the Moscow region. Material and methods. The study involved 198 third-year students of the Faculty of Medicine of the State University of Education, over the age of 18, living in Moscow and the Moscow region. The surveyed population did not have either acute or chronic diseases in the stage of decompensation, congenital malformations, ultra-low or excess body weight. An anthropometric study was carried out with measurements of the longitudinal and transverse dimensions of the torso and limbs, calculation of the body mass index, determination of the somatotype and subsequent statistical processing of the data obtained. Conclusion. Anthropometric indicators of girls and boys living in the Moscow region have a number of features. Persons with a mesomorphic somatotype predominate, which indicates the harmonious physical development of boys and girls. Most girls have a transversely narrowed shape of the pelvis, which indicates a possible risk of obstetric complications in the event of pregnancy and childbirth. Otherwise, both boys and girls develop proportionally in accordance with the parameters of the biological and physiological norm.

Impact of inflammatory bowel disease on women's reproductive life: a questionnaire-based study.

Inflammatory bowel diseases (IBDs) have a peak incidence between the second and fourth decades of life and can affect women's reproductive life. Our study aimed to assess the impact of IBD on the reproductive life of female patients with this condition. Cross-sectional study. Women with IBD followed at our IBD Unit and a group of healthy controls were enrolled. Data on reproductive life were collected using a dedicated questionnaire. The study included 457 women, of whom 228 had IBD, and 229 age-matched healthy controls. No differences were found in the use of contraceptives, infertility, and endometriosis. The risk of spontaneous and voluntary abortions was significantly higher in IBD patients than in healthy controls [odds ratio (OR) 2 and 3.62, respectively]. The risk of obstetrical complications in the IBD population was more than six times higher in patients who experienced disease reactivations during pregnancy than in those with persistent remission [OR 6.9, 95% confidence interval (CI) 1.51-31.28]. Finally, we found that the chances of breastfeeding were 66% lower in patients with IBD than in controls (OR 0.44, 95% CI 0.22-0.91). Our study underlines the negative impact of IBD on women's reproductive life, supporting the need for proactive preconception counseling.

Mode of Delivery and Obstetric Complications in the Setting of Prior Uterine Surgery.

This study aimed to evaluate cesarean rates and risk for obstetric complications among deliveries with a history of prior uterine surgery. This serial cross-sectional study analyzed deliveries with and without prior uterine surgery in the 2016-2019 Nationwide Inpatient Sample. Unadjusted and adjusted logistic regression models were performed to assess risk of nontransfusion severe maternal morbidity (SMM) and other obstetric complications based on the presence or absence of prior uterine surgery with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association. Adjusted models accounted for demographic, hospital, and delivery factors. Demographics and clinical factors among deliveries with and without a prior history of uterine surgery diagnosis were compared with the chi-square test with p < 0.05 considered statistically significant. Of 14.7 million delivery hospitalization identified, 6,910 (4.7 per 10,000) had a history of uterine surgery and 111,710 (0.76%) experienced SMM. Women with prior uterine surgery were more likely to be older, to be of unknown race or ethnicity, and to have private insurance (p < 0.01 for all). Eighty-five percent of deliveries with prior uterine surgery were performed by cesarean compared with 32% of deliveries without prior uterine surgery (p < 0.01). In adjusted analysis, compared with patients without prior uterine surgery, patients with prior uterine surgery were not at increased risk for SMM (aOR 1.23, 95% CI 0.73-2.07). Evaluating obstetric complications, patients with prior uterine surgery had a decreased risk of postpartum hemorrhage (aOR 0.64, 95% CI 0.43-0.96) and an increased risk of peripartum hysterectomy (aOR 4.12, 95% CI 1.75-9.67), and no difference in other obstetric complications assessed. These findings suggest that current clinical practice results in similar delivery risks among patients with compared with without prior uterine surgery. · Risk for most adverse outcomes is similar among patients with prior uterine surgery.. · Risk for peripartum hysterectomy was higher with prior uterine surgery.. · Risk for SMM was not higher with prior uterine surgery..

Features of pregnancy course in patients with thrombophilia and abnormal placenta location

Aim: to identify inherited and acquired thrombophilia as well as features of pregnancy course in women with abnormal placenta location.Materials and Methods. Within the framework of a prospective controlled cohort non-randomized, interventional study there was analyzed pregnancy course in 135 women with abnormal placenta location: group I – 42 patients with abnormal placenta location in history; group II – 61 women with placenta previa detected during ongoing pregnancy; group III – 32 patients with placenta previa detected both in ongoing and previous pregnancy. The control group consisted of 120 pregnant women with normal placenta location without a previous complicated obstetric history. All patients underwent clinical examination of pregnancy course assessing fetus intrauterine growth retardation (IUGR) and fetal biophysical profile; inherited and acquired thrombophilia were identified – analyzing circulating antiphospholipid antibodies (APAs) by ELISA, inherited thrombophilia by polymerase chain reaction to identify mutations in genes encoding 5,10methylenetetrahydrofolate reductase (MTHFR), G20210A mutations in prothrombin gene, V Leiden mutation, polymorphismin fibrinogen and plasminogen activator inhibitor 1 (PAI-1) genes.Results. Inherited thrombophilia was detected in 101 (74.81 %) pregnant woman with abnormal placenta location: group I – in 31 (73.8 %) patients, group II and group III – in 44 (72.1 %) and 26 (81.3 %) patients, respectively. Inherited forms of thrombophilia were detected in 29 (24.2 %) women from control group. Multigenic forms of thrombophilia peaked in group III (14/43.8 %), followed by group I (16/38.1 %) and group II (23/37.7 %). In the control group, multigenic thrombophilia was detected in 16 (13.3 %) women. Selective inherited thrombophilia and АРАs circulation were detected in 30 (22.22 %) women with abnormal placenta location: group I – in 8 (19.0 %) patients, group II – in 13 (21.3 %), and group III – in 9 (28.1 %) cases. In the control group, there were only 8 (6.7 %) such patients. Patients with IUGR signs were identified in all study groups: 4 (9.52 %) in group I, 6 (9.84 %) in group II, 6 (18.75 %) in group III as well as in control group in 6 (6.67 %) women.Conclusion. Pregnancy management in patients with thrombophilia and placental abnormalities should be accompanied by an proper fetal assessment (biophysical profile) and, in some cases, anticoagulant or antiplatelet therapy. However, insufficient number of cases requires to conduct further investigations to assess a relation between thrombophilia, placenta previa and a risk of obstetric complications particularly IUGR.

P-269 trophectoderm grade is associated with the risk of placenta previa in frozen-thawed single blastocyst transfer cycles

Abstract Study question Dose obstetric and perinatal complications differ among different blastocyst developmental parameters after frozen-thawed single blastocyst transfer (SBT) cycles? Summary answer Blastocysts with grade C trophectoderm (TE) were associated with an increased risk of placenta previa compared to those with grade A TE. What is known already Existing studies investigating the effect of blastocyst morphology grades on birth outcomes have mostly focused on fetal growth and have produced conflicting results, while the risk of obstetric complications has rarely been reported. Additionally, growing evidence have suggested that the appearance of TE cells could serve as the most important parameter for predicting implantation and live birth. Given that the TE ultimately develops into the placenta, it is plausible that this independent predictor may also impact placentation. Study design, size, duration This was a retrospective cohort study conducted at a single tertiary-care academic reproductive center. A total of 6168 patients who underwent frozen-thawed SBT and resulted in singleton delivery beyond 20 weeks of gestation between January 2017 and December 2021 were analyzed. Participants/materials, setting, methods Main outcomes included placenta previa, placental abruption, placenta accreta, pregnancy-induced hypertension (PIH), preeclampsia, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Multivariate logistic regressions were performed to evaluate the effect of blastocyst developmental stage (day 5 and 6), embryo expansion stage (stages 3, 4, 5 and 6), inner cell mass (ICM) grade (A, B and C), and TE grade (A, B and C) on measured outcomes adjusting for potential confounders. Main results and the role of chance The overall rates of placenta previa, placental abruption, placenta accreta, PIH, preeclampsia, PTB, LBW and SGA was 2.8% (n = 173), 0.4% (n = 26), 1.3% (n = 83), 5.3% (n = 328), 4.3% (n = 267), 6.8% (n = 417), 3.7% (n = 230), and 2.8% (n = 172), respectively. Specifically, the incidence of placenta previa derived from blastocyst with TE of grade C was higher compared with those derived from blastocyst with TE of grade A (1.8%, 2.5% and 3.9% for A, B and C, respectively, P = 0.003 for all comparisons). No such differences were observed for any other outcomes. After adjusting for potential covariates (maternal age, maternal BMI, maternal education, duration of infertility, gravidity, parity, previous caesarean section, infertility diagnosis, IVF or ICSI, previous embryo transfer, and type of endometrial preparation), TE grade C blastocyst had 2.58 times the likelihood of resulting in the risk of placenta previa compared to TE grade A blastocysts (adjusted odds ratio [AOR] 2.58, 95% confidence interval [CI] 1.05-6.31). No statistically significant associations were detected between any other measured outcomes and blastocyst developmental parameters. Furthermore, when restricted to pregnancies above 28 gestational weeks, the risk of placenta previa remained significantly higher with TE of grade C (AOR 2.56, 95% CI 1.05-6.27) than with TE of grade A. Limitations, reasons for caution The retrospective design, lack of controlling for residual confounding factors, and inter-observer variability limited this study. Wider implications of the findings The study extends our knowledge of the potential downstream effect of TE grade on placental abnormalities. Trial registration number not applicable

Obstetric complications and genetic risk for schizophrenia: Differential role of antenatal and perinatal events in first episode psychosis.

Obstetric complications (OCs) are key contributors to psychosis risk. However, it is unclear whether they increase psychosis vulnerability independently of genetic risk, in interaction with it, or are a manifestation of psychosis proneness. We examined the role of distinct types of OCs in terms of psychosis risk and tested whether they interact differently with genetic vulnerability, whilst accounting for other known environmental risk factors. 405 participants (219 first episode psychosis patients and 186 healthy volunteers) underwent a comprehensive assessment of OCs, measured using the Lewis-Murray scale and divided into complications of pregnancy, abnormalities of foetal growth and development, and complications of delivery. Participants were compared in terms of history of OCs, polygenic risk score for schizophrenia (PRS-SZ) and interactions between these. Both complications of pregnancy and abnormalities of foetal growth were significantly associated with case-control status (p=0.02 and 0.03, respectively), whereas complications of delivery were not. PRS-SZ showed a significant association with psychosis (p=0.04), but there were no significant interactions between genetic risk for schizophrenia and OCs, either when these were considered globally or separated based on their timeframe. We observed no significant interaction between genetic and obstetric vulnerability, yet distinct types of OCs may have a different impact on psychosis risk, based on their nature and timeframe. Examining their differential role might clarify their relative contributions to this risk.

Management and survival of foetuses with trisomy 18 in a French retrospective cohort Prise en charge et survie des fœtus porteurs de trisomie 18 dans une cohorte française rétrospective.

The main objective of this study was to evaluate parents' current demands following the announcement of trisomy 18 and maternal risks. A single-centre retrospective study was performed in the Paris Saclay Foetal Medicine Department from 2018 to 2021. All patients followed up in the department who had cytogenetic confirmation of trisomy 18 were included. 89 patients were recruited. The most common malformations at ultrasound examination were cardiac or brain abnormalities, distal arthrogryposis as well as severe intrauterine growth retardation. 29% of foetuses with trisomy 18 had more than three malformations. 77.5% of patients requested medical termination of pregnancy. Among the 19 patients who chose to continue their pregnancy, 10 (52.6%) presented with obstetrical complications, of which 7 (41.2%) experienced stillbirth; five babies were born alive with no survival at 6 months. In France, in the case of foetal trisomy 18, most women request termination of pregnancy. In the post-natal period, the management of a newborn with trisomy 18 is oriented towards palliative care. The mother's risk of obstetrical complications should be part of counselling. Follow-up, support and safety should be the goal of management of these patients, regardless of the patient's choice.

MEDICAL AND SOCIAL CHARACTERISTICS OF WOMEN WHO CONTRACTED COVID-19 DURING PREGNANCY

Introduction. Pregnant women are at a higher risk of a severe course of the coronavirus infection, including severe acute respiratory syndrome. They were identified as vulnerable groups with recommendations to take additional precautions since the onset of the COVID-19 pandemic.&#x0D; The aim of the study is to investigate the frequency and structure of risk factors for perinatal complications in women who contracted COVID-19 during pregnancy.&#x0D; Materials and methods. Analysis of clinical epidemiological and medical statistical data of the primary medical documentation (390 medical records) was carried out. The findings of 190 women who contracted COVID-19 during pregnancy (main group) were studied. We compared parameters of the test group with respective parameters of 200 women of the control group who did not contract COVID-19 during pregnancy. Age parameters, social status, somatic, reproductive and anamnesis data were investigated. Statistical processing of the results obtained was carried out using the package of application programs "Statistica 7.0" using the Excel 2013 standard package of statistical analysis. Credibility between different groups was examined based on the Pearson χ² test. Differences were considered plausible at a significance level of p&lt;0.05.&#x0D; Results. The findings from the primary medical records of 190 women who contracted COVID-19 during pregnancy in 2021 were analyzed. The study has demonstrated that these women were significantly more often older than 36 years of age compared to the control group, they were significantly more likely to have complicated reproductive anamnesis: 28.4% vs. 10.5%, mainly based on all the parameters studied: spontaneous miscarriages, infertility and stillbirth (р&lt;0.05). Somatic anamnesis in women of the main group was significantly more often burdened: 70.0% vs. 35.5%, p&lt;0.05), due to the significant prevalence of endocrine pathology (14.2% vs. 5.0% in the control group), the cardiovascular disorders (10.0% vs. 4.0%, respectively), the urinary disorders (8.4% vs. 3.0%), and diseases of the respiratory system (18.0% vs. 1.5%) in women of the control group (р&lt;0.05). Conclusion. The results obtained have shown that the risk factors for possible perinatal complications in women who contracted COVID-19 during pregnancy the most likely include the age over 36 years (13.5%), complicated reproductive anamnesis (28.4%), and the presence of somatic diseases (70.0%). Women who have contracted COVID-19 during pregnancy are at risk for obstetric complications.

Valvular heart disease in pregnancy

Key content Pregnancy‐induced changes in haemodynamic physiology can place considerable strain on cardiac function in some women with valvular disease. Regurgitant valve lesions are usually better tolerated in pregnancy than stenotic lesions, although the risk of obstetric complications is increased in both. Pre‐conception counselling is essential for all women with valvular disease. Optimising anticoagulation is a particular challenge in women with mechanical valves. Learning objectives To understand the World Health Organization (WHO) classification of maternal cardiac disease and how this affects counselling regarding decisions around pregnancy for women with valve pathology. To understand how valve disease affects pregnancy and vice versa. To gain insight into the anaesthetic and haematological considerations for managing women with valvular disease. Ethical issues What is the optimum anticoagulation regimen for women with mechanical heart valves in pregnancy that balances both maternal and fetal risks?

Previous surgery for endometriosis: a further risk for obstetric complications?

Previous surgery for endometriosis: a further risk for obstetric complications?

Pathogenetic significance of antiphospholipid antibodies in the development of placenta-associated complications in pregnant women with thrombocytopenia

BACKGROUND: Thrombocytopenia is one of the most common cytopenic syndromes that complicate pregnancy. It is considered a typical hematological criterion and the second most common manifestation of antiphospholipid syndrome. In recent years, the relationship between the development of thrombotic and placenta-associated pregnancy complications and the circulation of antiphospholipid antibodies has been actively studied, which makes it necessary to search for new methods for hemostasis correction and for prevention of the development of obstetric complications.&#x0D; AIM: The aim of this study was to assess the incidence of antiphospholipid antibodies in pregnant women with thrombocytopenia in order to determine the risk of obstetric complications and adverse pregnancy outcomes depending on the presence of antiphospholipid antibodies in the examined women.&#x0D; MATERIALS AND METHODS: 299 pregnant women were included in this multicenter prospective study: the main study group (n = 249) consisted of patients with thrombocytopenia, and the control group (n = 50) comprised women with normal platelet counts during a physiological pregnancy. All participants underwent a complete clinical and anamnestic examination and a study of the hemostasis system. To determine antibodies to cardiolipin, beta-2 glycoprotein 1, annexin V, and prothrombin (IgG/IgM/IgA), we performed enzyme-linked immunosorbent assay in 84 pregnant women with thrombocytopenia and in 25 women in the control group. Lupus anticoagulant was determined in 123 pregnant women of the main group and 25 women in the control group using an ACL-200 coagulometer (Instrumentation Laboratory, Spain).&#x0D; RESULTS: A comparative analysis of antiphospholipid antibodies detection has shown that in pregnant women with thrombocytopenia, lupus anticoagulant was detected in every third case (35.8% of cases, 44/123 women), which is more common than in the control group (8.0% of cases, 2/25 women; p = 0.008). Antibodies to beta-2 glycoprotein 1 were detected in pregnant women with thrombocytopenia in every fourth case (27.4% of cases, 23/84 women), and in the control group only in 4% of cases (1/25 women; p = 0.013). Antibodies to cardiolipin were also more often detected in pregnant women with thrombocytopenia (23.8% of cases, 20/84 women) compared to the control group (4% of cases, 1/25 women; p = 0.040). Based on the data obtained with V Cramer, we established medium-strength direct correlations between criterial antiphospholipid antibodies circulation and the development of placenta-associated complications of pregnancy (p 0.05; 0.2 V 0.4). We also identified statistically significant risks of developing placenta-associated complications in pregnant women with circulating antiphospholipid antibodies (95 % confidence interval excludes 1).&#x0D; CONCLUSIONS: Thrombocytopenia during pregnancy develops more often in women with antiphospholipid antibodies. Antiphospholipid antibodies circulation elevates coagulation potential and activates intravascular coagulation, resulting in an increased risk of placenta-associated complications of pregnancy, which requires hemostasis correction.

Relationship between Oral Health Knowledge and Maternal Oral Health with Obstetric Risk and Breastfeeding.

The relationship between maternal gingival health status and low birth weight or preterm delivery is controversial. The aim of this study was to analyze the association between maternal oral knowledge and the level of oral health during pregnancy with the risk of obstetric complications and breastfeeding. A descriptive cross-sectional study was conducted after an oral health educational intervention in a consecutive sample of 97 pregnant women. Data collection consisted of a validated questionnaire, oral examination, the Caries Index (CAOD) and the Simplified Oral Hygiene Index (IHOS). The participants had a mean age of 32.5 ± 5.19 years and a predominantly university education (57.1%). The level of knowledge regarding oral health was fair (12.5 ± 3.56 correct answers). Older pregnant women (33.0 ± 4.80 years) practiced breastfeeding and had a higher number of correct answers to the questionnaire. Adequate IHOS was associated with higher birth-weight newborns (3333 ± 0.3), whereas poor oral hygiene control was associated with lower birth-weight newborns (2960 ± 0.1) (p < 0.05). A lower level of academic education was associated with worse oral hygiene (p < 0.05). In addition, the greater the number of children, the higher the CAOD. Finally, among non-smoking women, the weight of infants was 437 mg higher. Maternal oral hygiene and the week of delivery were associated with newborn weight (p < 0.05) in a multiple linear regression model. Smoking was also related to low birth weight (p < 0.05). Educational interventions in pregnancy are necessary to decrease the incidence of obstetric adverse effects and improve the oral health of mothers and their children.

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

BackgroundTo evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM.MethodsA retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups.ResultsWomen who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07–1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45–4.15) were significant independent predictors of adverse outcomes after CM.ConclusionsCM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.

PECULIARITIES OF PREGNANCY AND DELIVERY IN WOMEN WITH HISTORY OF INFERTILITY

Institute of Hereditary Pathology of the National Academy of Medical Sciences of Ukraine, Lviv. Ukraine. Objective: to analyze data on somatic, reproductive, gynaecological history, pregnancy course and outcomes in women with a history of infertility residing in the Lviv region. Material and methods. The data and results of medical genetic counselling of 170 women aged 18-42 with a history of infertility (main group) were analyzed. The comparison was carried out with similar parameters of 80 healthy women aged 18-42 years in the control group. The data of somatic, reproductive, gynecological anamnesis, the pregnancy course and outcomes were studied. Statistical processing of the findings obtained was carried out by the Statistica 7.0 software package using the standard Excel 2013 statistical analysis package. Differences were considered statistically significant at p &lt;0.05. Results. The analysis of the data of the results of medical genetic counselling of 170 women with a history of infertility for 2019-2021 was carried out. The patients with a history of infertility were significantly more likely to be over 36 years of age compared to the same indicators in the control group. They had a complicated somatic anamnesis, 80.0% versus 20.0% in the control group, with a significant predominance of cardiovascular pathology (21.8% and 11.2%), and they also more often had reproductive history complications, 51 (30.0%) versus 11 (13.7%), mainly due to spontaneous miscarriages and missed pregnancies: 46 (27.0%) and 11 (13.7%), respectively. The gynaecological history in all these patients was complicated by infertility, and only infertility was in 113 (66.5%); infertility in combination with ovarian apoplexy was found in 17 (10.0%) and with ectopic pregnancy in 15 (8.8%) that was significantly higher in relation to respective data in the control group of women: 2 (2.6%) and 1 (1.3%), respectively. In women with a history of infertility, a high incidence of pregnancy complications was noted: 146 (85.9%) versus 39 (48.75%) in the control group: they more often gave birth for the first time: 110 (64.7%), and 35 (43.7%) in the control group. Analysis of the data obtained showed the presence of a large number of maternal risk factors for obstetric complications in this group of women. Conclusion. The study has demonstrated the risk factors for the occurrence of obstetric pathology in women with a history of infertility include presumably older age (over 36 years) (13.5%), a complicated reproductive history (30.0%) mainly due to spontaneous miscarriages and missed pregnancies (27.0%); complicated somatic history (80.0%) with a significant predominance of the pathology of the cardiovascular system (21.8%). A gynaecological history aggravated by infertility was found in all 170 (100.0%) women of the main group, and a significant increase in the combination of infertility with ovarian apoplexy was detected in 17 (10.0%) and with ectopic pregnancy in 15 (8.8%) women compared with the control group: 2 (2.6%) and 1 (1.3%), respectively. The complicated course of pregnancy was found in 85.9% of women with a history of infertility and in 48.75% of women in the control group; they more often gave birth for the first time: 110 (64.7%) versus 35 (43.7%) patients in the control group (p&lt;0.05). Women with a history of infertility are at risk for obstetric complications.

FEATURES OF THE USE OF OBSTETRIC ANAESTHETIC SUPPORT FOR PREGNANT WOMEN WITH COVID-19

Annotation: The available data on COVID-19 and pregnancy indicate that pregnancy and childbirth increase the likelihood of infection with the virus due to changes in the body, primarily in the respiratory and immune system organs. However, the association with the deterioration of the clinical picture in comparison with non-pregnant women of the same age group has not been proven. In this article (literature review), we analyzed data about how COVID-19 affects the course of pregnancy and examined the features of the application of anesthesia for patients undergoing cesarean section, based on international experience, due to the fact that pregnant women who develop pneumonia associated with COVID-19, have an increased risk of obstetric complications, premature birth, premature rupture of membranes, preeclampsia, cesarean section. Complications associated with a new coronavirus infection increase the need to receive anesthesia, which should be safe for the woman in labor, the fetus and medical personnel. Our knowledge of the epidemiology, pathogenesis, disease progression and clinical course of COVID-19 is constantly changing as more and more information becomes available. The research is based on articles on cases, case series, observational studies and randomized controlled trials describing women affected by coronavirus during pregnancy issued in 2019-2021. As a result of the study, it was concluded that in pregnant and maternity women with COVID-19, it is recommended to use conduction analgesia methods.

Influence of Uterine Cavity Breach in Laparoscopic Myomectomy on the Risk of Obstetric Complications.

Prepregnancy myomectomy is effective for the treatment of infertility or prevention of obstetric complications and is usually performed with laparoscopy. However, pregnancies following myomectomy have risks of obstetric complications, especially in cases with uterine cavity breaches, but the evidence remains unclear. We investigated how uterine cavity breach in laparoscopic myomectomy influenced the occurrence of obstetric complications. One hundred and eighty women who underwent a cesarean section from 2014 to 2020 in pregnancies following laparoscopic myomectomy were included. They were divided into two groups: 25 women in the uterine cavity breach group and 155 in the nonbreach group. Obstetric complications, including placenta accreta spectrum (PAS), uterine rupture, placental malposition, abruption placenta, preterm delivery, threatened premature labor, premature rupture of membranes, and massive intrapartum hemorrhage, were assessed. Multivariate analysis revealed that the frequency of PAS in the breach group (24.0%) was statistically significantly higher than in the nonbreach group (5.2%, P < 0.05). This study demonstrated that women who experienced uterine cavity breach in laparoscopic myomectomy had an increased risk of PAS in subsequent pregnancies.

Prematurity risk in association with human papillomavirus infection

Prematurity is an important cause of neonatal morbidity and mortality. Recent studies have shown that human pa­pil­lo­mavirus (HPV) infection also extends to the newborn. During pregnancy, the risk of obstetric complications, such as preterm premature rupture of fetal membranes (PPROM), prematurity, preeclampsia and spontaneous abor­tion, increase through inflammatory changes induced in trophoblast cells and, thus, through histopathologically iden­ti­fied placental abnormalities. The prevalence of HPV is increasing among young population, with a peak around the age of 25 years old. In addition, other infectious diseases, such as bacterial vaginosis and tri­cho­mo­nia­sis, can also act to cause PPROM by similar me­ch­a­nisms. Worldwide, there are three types of inactivated HPV vaccines (bivalent, quadrivalent and 9-valent), with the latter (Gardasil-9®) being currently the most recommended for use in the general population. Even though HPV vaccination will never reach a 100% coverage, its implementation in na­tio­nal immunization programs worldwide is one of the key solutions needed in order to reduce the impact of pre­ma­tu­ri­ty on the newborn.

Pregnancy and COVID-19: prevention, vaccination, therapy, and beyond

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has alarmed the world since its first emergence. As pregnancy is characterized by significant changes in cardiovascular, respiratory, endocrine, and immunological systems, there are concerns on issues like the course of disease in pregnant women, safety of medications, route of delivery and risk of obstetric complications. The aim of this review is to summarize the current literature in the management of pregnant women during the COVID-19 pandemic. Although more than 90% of pregnant women with COVID-19 recover without serious morbidity, rapid deterioration of disease and higher rates of obstetric complications may be observed. The risk of vertical transmission has not been clearly revealed yet. Decreasing the number of prenatal visits, shortening the time allocated for the examinations, active use of telemedicine services, limiting the number of persons in healthcare settings, combining prenatal tests in the same visit, restricting visitors during the visits, providing a safe environment in healthcare facilities, strict hygiene control, and providing personal protective equipment during the visits are the main strategies to control the spread of disease according to current guidelines. Although new medication alternatives are being proposed every day for the treatment of COVID-19, our knowledge about the use of most of these drugs in pregnancy is limited. Preliminary results are promising for the administration of SARS-CoV-2 vaccines in the pregnant population. Timing of delivery should be decided based on maternal health condition, accompanying obstetric complications and gestational age. Cesarean delivery should be performed for obstetric indications. Breast feeding should be encouraged as long as necessary precautions for viral transmission are taken. In conclusion, an individualized approach should be provided by a multidisciplinary team for the management of pregnant women with COVID-19 to achieve favorable outcomes.