Severe Adverse Neonatal Outcomes Research Articles

Pregnancy planning and neonatal outcome - a retrospective cohort study

BackgroundUnplanned pregnancy is common, and although some research indicates adverse outcomes for the neonate, such as death, low birth weight, and preterm birth, results are inconsistent. The purpose of the present study was to investigate associated neonatal outcomes of an unplanned pregnancy in a Swedish setting.MethodsWe conducted a retrospective cohort study in which data from 2953 women were retrieved from the Swedish Pregnancy Planning Study, covering ten Swedish counties from September 2012 through July 2013. Pregnancy intention was measured using the London Measurement of Unplanned Pregnancy. Women with unplanned pregnancies and pregnancies of ambivalent intention were combined and referred to as unplanned. Data on neonatal outcomes: small for gestational age, low birth weight, preterm birth, Apgar score < 7 at 5 min, and severe adverse neonatal outcome defined as death or need for resuscitation at birth, were retrieved from the Swedish Medical Birth Register.ResultsThe prevalence of unplanned pregnancies was 30.4%. Compared with women who had planned pregnancies, those with unplanned pregnancies were more likely to give birth to neonates small for gestational age: 3.6% vs. 1.7% (aOR 2.1, 95% CI 1.2–3.7). There were no significant differences in preterm birth, Apgar score < 7 at 5 min, or severe adverse neonatal outcome.ConclusionsIn a Swedish setting, an unplanned pregnancy might increase the risk for birth of an infant small for gestational age.

Abnormal Shape and Size of the Cardiac Ventricles Are Associated with a Higher Risk of Neonatal Death in Fetuses with Isolated Left Congenital Diaphragmatic Hernia

Introduction: The objective of this study was to evaluate the association between fetal cardiac deformation analysis (CDA) and cardiac function with severe adverse perinatal outcomes in fetuses with isolated left congenital diaphragmatic hernia (CDH). Methods: CDA in each ventricle (contractility, size, and shape), evaluated by speckle tracking and novel FetalHQ software, and markers of cardiac function (E/A ratios, pulmonary and aortic peak systolic velocities, and sigmoid annular valve diameters), were evaluated in fetuses with isolated left CDH. Two evaluations were performed: at referral (CDA and function) and within 3 weeks of delivery (CDA). Severe adverse neonatal outcomes were considered neonatal death (ND) or survival with CDH-associated pulmonary hypertension (CDH-PH). Differences and associations between CDA, cardiac function, and severe adverse outcomes were estimated. Results: Fifty fetuses were included, and seventeen (34%) had severe adverse neonatal outcomes (11 ND and 6 survivors with CDH-PH). At first evaluation, the prevalence of a small left ventricle was 34% (17/50) with a higher prevalence among neonates presenting severe adverse outcomes (58.8 [10/17] vs. 21.2% [7/33]; p = 0.01; OR, 5.03 [1.4–19.1; p = 0.01]) and among those presenting with neonatal mortality (8/11 [72.7] vs. 9/39 [23.0%]; p = 0.03; OR, 8.9 [1.9–40.7; p = 0.005]). No differences in cardiac function or strain were noted between fetuses with or without severe adverse outcomes. Within 3 weeks of delivery, the prevalence of small left ventricle was higher (19/34; 55.8%) with a more globular shape (reduced transverse/longitudinal ratio). A globular right ventricle was significantly associated with ND or survival with CDH-PH (OR, 14.2 [1.5–138.3]; p = 0.02). Conclusion: Fetuses with isolated CDH at risk of perinatal death or survival with CDH-PH had a higher prevalence of a small left ventricle and abnormal shape of the right ventricle.

993 Plasma sFlt-1/PlGF ratio in mom and severe adverse neonatal outcomes in non-preeclamptic patients

993 Plasma sFlt-1/PlGF ratio in mom and severe adverse neonatal outcomes in non-preeclamptic patients

Safety of Alprazolam Use in Pregnancy in Western Australia: A Retrospective Cohort Study Using Linked Health Data

ABSTRACT The use of alprazolam in pregnancy can adversely affect maternal and neonatal health. This study examined neonatal outcomes following exposure to alprazolam in pregnancy. Women prescribed alprazolam during pregnancy (n = 48) between 2014 and 2018 were identified from routinely-collected state administrative prescribing records and perinatal data. Two comparison groups of women; 1) prescribed alprazolam outside of pregnancy (n = 96) and 2) women never prescribed alprazolam (n = 96) were also identified. The health of women and their children was examined using administrative hospital, mortality and perinatal data and compared to the comparison groups using generalized linear models. Prenatal alprazolam exposure was not associated with a reduction in average birth weight or gestational age. However, neonates prenatally exposed to alprazolam were more likely be classified as having low birth weight for gestational age compared with alprazolam comparison group (OR: 4.46, 95% CI: 1.54–12.95) and the non-alprazolam comparison group (OR: 3.27, 95% CI: 1.22–8.79). There were no cases of perinatal mortality or floppy baby syndrome in alprazolam-exposed neonates. While the use of alprazolam during pregnancy was not associated with an increased risk of severe adverse neonatal outcomes (e.g. perinatal mortality), it was associated with neonates being born with a low birth weight for gestational age.

Impact on Neonatal Outcomes with Late Preterm and Early Term Delivery in Women with Diabetes.

Late preterm and early term deliveries are common in pregnancies complicated by diabetes due to higher rates of obstetric complications including increased stillbirth risk. However, early delivery is associated with multiple neonatal adverse outcomes, which may be further increased by maternal diabetes. We examined whether there is an additive effect on adverse neonatal outcomes in the setting of maternal diabetes in the late preterm and early term periods. This was a retrospective cohort study of women with a singleton, nonanomalous pregnancy delivering at a single academic medical center in the late preterm (340/7-366/7 weeks) or early term (370/7-386/7 weeks) period between 2010 and 2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or gestational diabetes (GDM). Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent. A total of 8,072 pregnancies were included with T1DM, T2DM, and GDM complicating 1.8, 5.6, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups including higher rates of non-Hispanic Black race, chronic hypertension, and higher body mass index in women with T2DM. The probability of severe composite adverse neonatal outcome was significantly increased in women with T1DM in the late preterm (aOR: 4.4; CI: 2.4-8.1) and early term (aOR: 1.6; CI: 1.1-2.3) periods, largely driven by the need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery but highest in women with T1DM. Pregnancies complicated by diabetes, particularly T1DM, have higher rates of neonatal adverse outcomes independent of gestational age at delivery, which is an important consideration when late preterm or early term delivery is planned. · Diabetes in pregnancy increases risk of early delivery.. · Adverse neonatal outcomes are higher with diabetes, especially T1DM.. · Adverse neonatal outcomes are independent of gestational age..

The Association Between the Number of Vacuum Pop-Offs and Adverse Neonatal Outcomes

ABSTRACT Vacuum-assisted vaginal delivery (VAVD) is used to expedite vaginal delivery in cases of an arrest of descent, maternal exhaustion, or concern for fetal well-being. In 2015, the rate of VAVD was greater than the use of forceps in the United States (2.58% vs 0.56%). Several studies have examined various characteristics of vacuum devices, such as cup shape and material, number of pulls, and number of pop-ups, which is defined as the spontaneous dislodgment of the cup from the fetal scalp. Vacuum manufacturers, such as Kiwi and Mityvac, recommend abandoning VAVD as an intervention after 2 or 3 pop-offs; however, the American College of Obstetricians and Gynecologists acknowledges that there are not enough data to recommend guidelines on how many pop-offs should be allowed before discontinuing. Some studies have demonstrated an increased risk of adverse neonatal outcomes with any number of pop-offs versus no pop-offs, whereas other studies have shown no independent association between the number of pop-offs and neonatal head injury. In addition, compared with an increase in the number of pop-offs, a large multicenter study found that increased duration of VAVD has a stronger association with adverse outcomes. The aim of this study was to examine the association between the number of pop-offs and adverse neonatal outcomes. This was a retrospective cohort study conducted at a single tertiary care institution from October 1, 2005, to June 1, 2014. Data were collected from electronic medical records. Included were adult women with singleton pregnancies who delivered via VAVD or a trial of VAVD followed by cesarean delivery. Excluded were those who underwent sequential trials of both vacuum and forceps. Institutional policy recommended converting to cesarean delivery after &gt;3 pop-offs, but the decision was left to the discretion of the physician. The primary outcome was a composite of severe adverse neonatal outcome, including brachial plexus injury, intracranial hemorrhage, convulsions, and central nervous system (CNS) depression. Other outcomes of study were scalp/facial lacerations, intracranial hemorrhage, seizures, CNS depression, and admission to the neonatal intensive care unit (NICU). A total of 1730 women were included in the analysis. Of these, 74.7% had no pop-offs, 13.9% had 1 pop-off, 7.4% had 2 pop-offs, and approximately 4% had ≥3 pop-offs. Approximately 94% delivered via VAVD. As the number of pop-offs increased, the number of scalp/facial lacerations, intracranial hemorrhage, subgaleal hemorrhage, convulsions, CNS depression, and NICU admissions significantly increased. However, there was no association with the composite outcome, as well as severe perinatal laceration, shoulder dystocia, brachial plexus injury, and cephalohematoma. Adjusting for confounders, having any number of pop-offs increased the likelihood of scalp/facial lacerations, intracranial hemorrhage, convulsions, CNS depression, and NICU admission. However, there was not a dose-dependent association in the odds of adverse outcomes as the number of pop-offs increased. Compared with having no pop-offs, having any number of pop-offs was associated with an increase in adverse neonatal outcomes. In addition, the rates of intracranial hemorrhage and subgaleal hemorrhage were increased with greater numbers of pop-offs.

Management of late-onset fetal growth restriction: pragmatic approach.

There is limited prospective evidence to guide the management of late-onset fetal growth restriction (FGR) and its differentiation from small-for-gestational age. The aim of this study was to assess prospectively a novel protocol in which ultrasound criteria were used to classify women with suspected late FGR into two groups: those at low risk, who were managed expectantly until the anticipated date of delivery, and those at high risk, who were delivered soon after 37 weeks of gestation. We also compared the outcome of this prospective cohort with that of a historical cohort of women presenting similarly with suspected late FGR, in order to evaluate the impact of the new protocol. This was a prospective study of women with a non-anomalous singleton pregnancy at ≥ 32 weeks' gestation attending a tertiary hospital in London, UK, between February 2018 and September 2019, with estimated fetal weight (EFW) ≤ 10th centile, or EFW > 10th centile in addition to a decrease in fetal abdominal circumference of ≥ 50 centiles compared with a previous scan, umbilical artery Doppler pulsatility index > 95th centile or cerebroplacental ratio < 5th centile. Women were classified as low or high risk based on ultrasound and Doppler criteria. Women in the low-risk group were delivered by 41 weeks of gestation, unless they subsequently met high-risk criteria, whereas women in the high-risk group (EFW < 3rd centile, umbilical artery Doppler pulsatility index > 95th centile or EFW between 3rd and 10th centiles (inclusive) with abdominal circumference drop or abnormal Dopplers) were delivered at or soon after 37 weeks. The primary outcome was adverse neonatal outcome and included hypothermia, hypoglycemia, neonatal unit admission, jaundice requiring treatment, suspected infection, feeding difficulties, 1-min Apgar score < 7, hospital readmission and any severe adverse neonatal outcome (perinatal death, resuscitation using inotropes or mechanical ventilation, 5-min Apgar score < 7, metabolic acidosis, sepsis, and cerebral, cardiac or respiratory morbidity). Secondary outcomes were adverse maternal outcome (operative delivery for abnormal fetal heart rate) and severe adverse neonatal outcome. Women managed according to the new protocol were compared with a historical cohort of 323 women delivered prior to the implementation of the new protocol, for whom management was guided by individual clinician expertise. Over 18 months, 321 women were recruited to the prospective cohort, of whom 156 were classified as low risk and 165 were high risk. Adverse neonatal outcome was significantly less common in the low-risk compared with the high-risk group (45% vs 58%; adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.9); P = 0.022). There was no significant difference in the rate of adverse maternal outcome (18% vs 24%; aOR, 0.7 (95% CI, 0.4-1.2); P = 0.142) or severe adverse neonatal outcome (3.8% vs 8.5%; aOR, 0.5 (95% CI, 0.2-1.3); P = 0.153) between the low- and high-risk groups. Compared with women in the historical cohort classified retrospectively as low risk, low-risk women managed under the new protocol had a lower rate of adverse neonatal outcome (45% vs 58%; aOR, 0.6 (95% CI, 0.4-0.9); P = 0.026). Appropriate risk stratification to guide management of late FGR was associated with a reduced rate of adverse neonatal outcome in low-risk pregnancies. In clinical practice, a policy of expectantly managing women with a low-risk late-onset FGR pregnancy at term could improve neonatal and long-term development. Randomized controlled trials are needed to assess the effect of an evidence-based conservative management protocol for late FGR on perinatal morbidity and mortality and long-term neurodevelopment. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Implementation of a Severe Maternal Morbidity Quality Review Process at a Level IV Public Hospital [ID: 1377992

INTRODUCTION: Severe maternal morbidity (SMM) is tracked by national organizations offering opportunities to evaluate, monitor, and address in near real time. Using a multidisciplinary case review committee to analyze all cases of SMM at a level IV inner-city hospital, we hypothesized that case reviews will identify opportunities for improvement in obstetric practices. METHODS: A case review was triggered for any delivery with an SMM ICD-10 code, transfusion of greater than 4 units, readmission within 48 hours of discharge, a patient safety concern by staff, or a severe adverse neonatal outcome. This cohort study included all of the case reviews of cases between 2019 and 2022. Severe maternal morbidity outcomes, demographics, and obstetric practices were analyzed. RESULTS: Of 36,671 deliveries, 296 (0.8%) met criteria and were reviewed. Of these, 80 (27%) had two or more concurrent SMM events. Postpartum hemorrhage was the most common (37%), followed by intensive care unit admission (13%) and hysterectomy (12%). After review, practices done well included interdisciplinary communication and prompt decision-making. Opportunities for improvement included inadequate access to peripartum care due to socioeconomic barriers, communication, and lack of role clarity. CONCLUSION: Social barriers, inadequate communication, and lack of role clarity were identified as the most common areas of improvement in SMM cases. These findings led to the development of an escalation of care pathway for massive transfusion protocol and vital signs thresholds at which to contact anesthesia. The implementation of a standardized SMM surveillance system results in systematic improvements in obstetric practices.

The association between undetected small-for-gestational age and abnormal admission cardiotocography: A registry-based study.

To assess the association between undetected small-for-gestational age (SGA) fetuses and abnormal admission cardiotocography (admCTG) in a low-risk population. An observational study. Four hospitals in Stockholm-Gotland, Sweden. A cohort of 127 461 deliveries between 1 February 2012 and 15 June 2020. This cohort was linked to the Swedish Neonatal Quality Register. Pregnancies were designated as high or low risk at the time of admission to the labour ward according to pre-defined risk measures. SGA was defined as a birthweight at or below the tenth centile and at or below the third centile for gestational age. The main outcome was the proportion of undetected SGA by admCTG (normal or abnormal). The secondary outcome was a composite severe adverse neonatal outcome for fetuses born less than 6 hours after admission (Apgar score <4 at 5 minutes, hypoxic-ischaemic encephalopathy grade of 2-3, neonatal seizures and neonatal death). The rate of abnormal admCTG was 4.9%. The proportion of SGA at or below the tenth centile was higher in the abnormal admCTG group than in the normal admCTG group, 18.6% versus 9.7% (odds ratio 2.1, 95% CI 1.9-2.3). Abnormal admCTG and SGA (≤10th) was associated with a more than 20-fold increased risk of an adverse outcome compared with normal admCTG and non-SGA (adjusted odds ratio 23.7, 95% CI 9.8-57.3). The latter had a risk of 1/2000 of an adverse outcome. In this low-risk population, undetected SGA fetuses were more prone to having abnormal admCTG and had a substantially higher risk of severe adverse neonatal outcomes.

Mild neonatal morbidity in twins by planned mode of delivery: a secondary analysis of the Twin Birth Study

The Twin Birth Study showed no differences in major severe adverse neonatal outcomes between those with planned vaginal delivery and those with planned cesarean delivery. This was a secondary analysis of the Twin Birth Study in which mild neonatal morbidities, not previously reported, were compared between parturients with planned cesarean deliveries and those with planned vaginal delivery in twin births. This was a secondary analysis of the Twin Birth Study. In this study, women with a twin pregnancy at 32+0/7 to 38+6/7 weeks of gestation with the first twin in cephalic presentation and with an estimated weight between 1500 and 4000 g were randomized to either planned cesarean delivery or planned vaginal delivery. The primary outcome of this study was a composite mild neonatal outcome of respiratory and neurologic morbidities and neonatal intensive care unit admission that were not reported in the original Twin Birth Study at 34+0/7 to 38+6/7 weeks of gestation. A multivariable logistic regression analysis was used to identify factors associated with the composite adverse neonatal outcomes. Neonatal outcomes were further stratified by gestational age at delivery and by actual mode of delivery. A total of 1304 women and 1326 women were randomly assigned to planned cesarean delivery and planned vaginal delivery, respectively. Demographic and obstetrical characteristics were similar between the study groups. The rate of cesarean delivery was 90.1% in the planned cesarean delivery group and 40.1% in the planned vaginal delivery group. There was no significant difference in the primary composite outcome between the groups (10.6% vs 11.3%; P=.45) neither by planned mode of delivery nor by actual mode of delivery. Stratification by gestational age found a lower rate of the primary outcomes at ≥38+0/7 weeks of gestation in the planned cesarean delivery group when compared with the planned vaginal delivery group (4.8% vs 10.8%, respectively; P=.02). Furthermore, a lower risk for some individual outcomes was reported in the planned cesarean delivery group when compared with the planned vaginal delivery group, including intraventricular hemorrhage stage 1 to 2 (0.2% vs 0.6%; P<.05), low Apgar scores (0.8% vs 2.3%; P<.05), pH <7.0 (0.3 vs 1%; P<.05), and assisted ventilation needed at delivery (0.4% vs 0.9%; P<.05). In twin deliveries, with the first twin in the cephalic presentation, composite mild neonatal morbidity was not affected by the planned mode of delivery. These findings reinforce the original results of the Twin Birth Study. Nevertheless, an increased composite outcome after 38 weeks' gestation and a higher risk for some individual morbidities in the planned vaginal delivery group might be viewed as a concerning signal for the safety of vaginal delivery in twin deliveries and requires further research.

Acceptance Rate of COVID-19 Vaccine and Its Determinants Among Indian Pregnant Women: A Hospital-Based Cross-Sectional Analysis.

Background Vaccination is more widespread when the determinants and hesitancy of vaccination are identified, especially in vulnerable groups, such as pregnant women. Pregnant women if infected with COVID-19 are more likely to get severe COVID-19 illness and adverse neonatal outcomes as compared to non-pregnant women. The present study was designed with the aim to estimate the rate of COVID-19 vaccine acceptance and to identify the associated factors which influence the vaccine acceptance. Methods This study was a hospital-based cross-sectional study conducted in the Obstetrics Department of Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, from February 2022 to April 2022. Our study included 298 pregnant women above 18 years who were willing to participate in the study. Information was collected by face-to-face interview using a structured and pretested questionnaire. Binomial logistic regression (univariate and multivariate) was used to identify the associated factors on vaccination acceptance. Results Among 298 pregnant women, 234 expressed willingness to receive vaccine, giving an acceptance rate of 78.52%. The educational status, ethnicity, occupation of the woman and husband, and type of family showed no significant relationship with the vaccine acceptance. On multivariate logistic regression analysis, the determinants found to be significantly associated with COVID-19 vaccine acceptance among pregnant women were as follows: Muslim religion (aOR=0.27, CI: 0.12-0.61), gravida >2 (aOR=1.84, CI: 1.30-2.61), and awareness that COVID-19 vaccine has been approved by the government (aOR=3.03, CI: 1.45-6.36). Awareness that COVID-19 infection causes more severe complications in pregnant women than non-pregnant women (aOR=1.89, CI: 0.93-3.87) and hypertension (aOR=0.36, CI: 0.11-1.20) were non-significantly associated. Conclusion The acceptance of COVID-19 vaccination was high in this study and was well received especially by mothers who had knowledge about the importance of vaccination during pregnancy. Concerns about the side effects of vaccination and the possibility of harming the baby were the main reasons for refusal. During prenatal care, health care providers should reinforce the benefits of COVID-19 vaccination during pregnancy.

Inflammatory Bowel Disease and Pregnancy

Inflammatory Bowel Disease and Pregnancy

O85 - Do Women with an Existing Perinatal Mental Health Concern Benefit from Caseload Midwifery?

Women with a history or current perinatal mental health (PMH) disorders have an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload practice (MCP) improves outcomes for women, including a 24% reduction in preterm birth rates. The Australian Clinical Practice Guidelines for PMH recommend MCP for women with PMH, though this is rarely implemented. Our aim was to compare obstetric and perinatal outcomes for women with a history of PMH between MCP and standard models of maternity care. Retrospective cohort study using routinely collected data of women with PMH between 1st January 2018 – 31st January 2021. We compared characteristics and outcomes between groups; adjusted for maternal age, gestational age, ethnicity, smoking, socioeconomic status, BMI, pregnancy complications and severity of mental health disorder. 3028 women with PMH, 352 (12%) received MCP. The commonest diagnosis was anxiety and depression (n=723, 23.9%). Women receiving MCP were younger (mean 30.9 vs 31.3, p=0.03), Caucasian (37.8 vs 27.1, p<0.001), from a postcode of advantaged (31.0% vs 20.2, p<0.001); less likely to smoke (5.1 vs 11.9, p<0.001) and lower BMI (mean 24.3 vs 26.5, p<0.001). Women in MCP had lower odds of preterm birth (adjOR 0.46, 95% CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95% CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95% CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95% CI 0.57-1.09). Evidence from this study demonstrates women with PMH who have continuity of midwifery care have improved outcomes compared to women with PMH who receive standard care. This provides further evidence that women are better together through midwifery continuity of care. Future RCTs for this group of women is needed to establish causation.

Prediction of Severe Adverse Neonatal Outcomes at the Second Stage of Labor Using Machine Learning: A Retrospective Cohort Study

(BJOG. 2021;128:1824–1832) During the second stage of labor, close maternal and neonatal monitoring is important for avoiding adverse outcomes. Machine learning has been used to analyze complex data patterns and has successfully predicted the need for emergent cesarean delivery (CD) and successful vaginal birth after CD. This study aimed to develop a model to predict adverse neonatal outcomes based on data available to clinicians before the onset of the second stage of labor using machine learning tools.

Severe Adverse Maternal and Neonatal Outcomes in Adolescent Mother-Newborn Dyads: A Multicentre Study in Latin America.

To compare the risk of severe adverse maternal outcomes (SMO) and neonatal outcomes (SNO) and analyse their maternal correlates in adolescent mother-newborn and young mother-newborn dyads in secondary and tertiary care users in Latin America. We performed a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health database in 83 secondary and tertiary hospitals in seven countries in Latin America. We constructed a composite indicator of both SMO and SNO and estimated odds ratios (OR) comparing adolescent mothers (aged 12-19) with young mothers (aged 20-24). Our unit of analysis was the mother-newborn dyad. We found that the combination of SMO and SNO was three times more likely in adolescent mother as compared to young mother dyads (OR 3.56; 95% CI 1.67-7.59). SNO either alone or in combination with SMO were more likely in adolescents aged 12 to 16 than in young women (OR 1.27 and 4.87, respectively). Adolescent mothers and their newborns are at an increased risk of severe adverse outcomes during child birth and in the first week postpartum compared to young mother dyads, especially young adolescents. Focusing on the dyad as a whole may facilitate a step towards integrated care which maximizes the health benefits of both mother and newborn. Continued efforts are needed to improve health care and prevention initiatives directed towards adolescent women and their newborns in Latin America.

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia

BackgroundPerinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. AimTo compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. MethodsA retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 – 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. ResultsThe cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24–0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93–3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10–4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57–1.09). ConclusionsThis evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.

Clinical Correlates of Placental Pathologic Features in Early-Onset Fetal Growth Restriction

Introduction: The purpose of this study was to evaluate the association between placental pathologic features of maternal (MVM) or fetal (FVM) vascular malperfusion and clinical characteristics, sonographic findings and neonatal outcome in a cohort of pregnancies complicated by early-onset (diagnosed before 32 weeks of gestational age) fetal growth restriction (FGR). Methods: A prospective cohort study included 250 singleton early-onset FGR pregnancies diagnosed, followed up and delivered at a single center. Placental pathologic lesions were classified according to standard recommendations. Logistic regression and Cox analysis were used to evaluate outcomes adjusting for confounders. Results: Overall features of severe placental MVM and FVM were observed in 29.6% (74/250) and 12.8% (32/250) of the subjects, respectively. Severe placental MVM lesions were more common among subjects with umbilical artery Doppler Pulsatility Index >95th than ≤95th percentile (50/120 as opposed to 24/130, Adj odds ratio [OR] = 3, 95% CI = 1.6–5.4) and Cerebroplacental ratio <5th than ≥5th percentile (48/115 as opposed to 26/135, Adj OR = 2.7, 95% CI = 1.5–4.9). Mean time from FGR diagnosis to delivery was shorter among subjects with severe MVM (25.5 days, 95% CI = 20.6–30.2, Adj. OR = 1.9, 95% CI = 1.9, 95% CI = 1.4–2.5) when compared to both those with mild/moderate MVM (36.5 days [95% CI = 27.2–45, p = 0.04]) or no MVM (39.4, 95% CI = 35.4–43.4, p < 0.001). Finally, severe FVM was associated with an increased risk of perinatal/neonatal death or severe brain lesions (9/28 in subjects with perinatal/neonatal death/brain lesions as compared to 23/222 in controls, Adj OR = 3, 95% CI = 1.05–8.6) or severe adverse neonatal outcomes (13/46 in subjects with severe adverse outcome as compared to 19/204 among controls, Adj OR = 3.2, 95% CI = 1.2–8.5). Conclusions: In early-onset FGR, placental pathologic features of MVM and FVM are, in different regards, associated to severity of clinical picture, abnormal Doppler markers of placental and fetal circulation and of neonatal outcome, respectively.

Subsequent pregnancy outcomes after abdominal vs. laparoscopic myomectomy

Objective To determine whether abdominal (open) vs. laparoscopic myomectomy affects the obstetrical outcomes of subsequent pregnancies. Methods A retrospective cohort study was conducted at a tertiary university medical center. The study population included women who had a documented birth following a myomectomy at our institution between the years 1997 and 2018. The obstetrical characteristics and immediate perinatal outcomes of the subsequent pregnancy following open vs. laparoscopic myomectomy were collected and compared. Data were retrieved from patients’ medical records via the institutional computerized database. Cases that lacked detailed surgery and delivery reports were excluded. Data were analyzed using a chi-square test for categorical variables and one-way ANOVA for continuous variables. A p-value <.05 was considered statistically significant. Results During the study period, 57 women met the inclusion criteria, of whom 66.6% (38/57) had an open and 33.3% (19/57) had a laparoscopic myomectomy. Women who underwent an open myomectomy had a higher rate of cesarean birth than those in the laparoscopic group (89.5 vs. 42.1%, p < .001). No cases of severe maternal or perinatal complications, uterine ruptures, or placental abruptions were identified in either study group. No other significant differences were noted between the two types of myomectomy. Conclusion Open myomectomy is associated with a higher rate of cesarean delivery than laparoscopic. No severe adverse maternal or neonatal outcomes were detected in either study group.

Prediction of severe adverse neonatal outcomes at the second stage of labour using machine learning: a retrospective cohort study.

To create a personalised machine learning model for prediction of severe adverse neonatal outcomes (SANO) during the second stage of labour. Retrospective Electronic-Medical-Record (EMR) -based study. A cohort of 73868 singleton, term deliveries that reached the second stage of labour, including 1346 (1.8%) deliveries with SANO. A gradient boosting model was created, analysing 21 million data points from antepartum features (e.g. gravidity and parity) gathered at admission to the delivery unit, and intrapartum data (e.g. cervical dilatation and effacement) gathered during the first stage of labour. Deliveries were allocated to high-risk and low-risk groups based on the Youden index to maximise sensitivity and specificity. SANO was defined as either umbilical cord pH levels ≤7.1 or 1-minute or 5-minute Apgar score ≤7. The model for prediction of SANO yielded an area under the receiver operating curve (AUC) of 0.761 (95% CI 0.748-0.774). A third of the cohort (33.5%, n=24721) were allocated to a high-risk group for SANO, which captured up to 72.1% of these cases (odds ratio 5.3, 95% CI 4.7-6.0; high-risk versus low-risk groups). Data acquired throughout the first stage of labour can be used to predict SANO during the second stage of labour using a machine learning model. Stratifying parturients at the beginning of the second stage of labour in a 'time out' session, can direct a personalised approach to management of this challenging aspect of labour, as well as improve allocation of staff and resources. Personalised prediction score for severe adverse neonatal outcomes in labour using machine learning model.

Predictors of poor neonatal outcomes in fetuses diagnosed with congenital urinary tract anomalie.

Urinary tract anomalies account for approximately one-quarter of all antenatally detected anomalies. The aim of this study was to identify factors associated with severe adverse neonatal outcomes of a prenatally diagnosed urinary tract anomaly. A retrospective-prospective study included 101 pregnant women with prenatally diagnosed fetal urinary tract anomalies presented to the Council for Fetal Anomalies. Prenatal diagnoses were compared with autopsy findings in cases of terminated pregnancy or with clinical and operative findings of the infants. The mortality rate in the group of patients with fetal obstructive uropathy (60 patients) was 10% and in the group of patients with fetal multicystic dysplastic kidney (38 patients) 15.7%. Surgery was performed on 53.4% of the children, whereas more than half of the operations involved resolving associated urinary tract anomalies. Postoperative renal function deterioration occurred in 19% of the children. The prognosis of renal function in obstructive uropathies is excellent if oligoamnios does not develop prenatally and in case of timely provided surgical care is provided postnatally. The finding of the bilateral multicystic dysplastic kidney is associated with poor prognosis. The prognosis in fetal unilateral multicystic dysplastic kidney depends primarily on the condition of the contralateral kidney and the existence of associated anomalies.