Severe Maternal Complications Research Articles

Development of a new definition of maternal near miss based on organ dysfunction in Latin America and the Caribbean: Aprospective multicenter cohort study.

There has been debate over whether the existing World Health Organization (WHO) criteria accurately represent the severity of maternal near misses. This study assessed the diagnostic accuracy of two WHO clinical and laboratory organ dysfunction markers for determining the best cutoff values in a Latin American setting. A prospective multicenter cohort study was conducted in five Latin American countries. Patients with severe maternal complications were followed up from admission to discharge. Organ dysfunction was determined using clinical and laboratory data, and participants were classified according to severe maternal outcomes. This study compares the diagnostic criteria of Latin American Centre for Perinatology, Network for Adverse Maternal Outcomes (CLAP/NAMO) to WHO standards. Of the 698 women studied, 15.2% had severe maternal outcomes. Most measured variables showed significant differences between individuals with and without severe outcomes (all P-values <0.05). Alternative cutoff values suggested by CLAP/NAMOs include pH ≤7.40, lactate ≥2.3 mmol/L, respiratory rate ≥ 24 bpm, oxygen saturation ≤ 96%, PaO2/FiO2 ≤ 342 mmHg, platelet count ≤189 × 109 × mm3, serum creatinine ≥0.8 mg/dL, and total bilirubin ≥0.67 mg/dL. No significant differences were found when comparing the diagnostic performance of the CLAP/NAMO criteria to that of the WHO standards. The CLAP/NAMO values were comparable to the WHO maternal near-miss criteria, indicating that the WHO standards might not be superior in this population. These findings suggest that maternal near-miss thresholds can be adapted regionally, improving the identification and management of severe maternal complications in Latin America.

Predictive value of platelet parameters for early-onset pre-eclampsia: A prospective cohort study in a teaching institution in Gujarat, India

ABSTRACT Background: Early-onset pre-eclampsia is associated with severe maternal and perinatal complications. Identifying novel biomarkers for early prediction is crucial for timely intervention and improved outcomes. This study aimed to evaluate the predictive value of platelet parameters, namely mean platelet volume (MPV), platelet distribution width (PDW), and platelet count (PC), for early-onset pre-eclampsia. Methods: A prospective cohort study was conducted at a tertiary care hospital in Gujarat, India. Pregnant women (n = 712) between 14 and 18 weeks of gestation were enrolled and followed up until delivery. MPV, PDW, and PC were measured at enrollment. The primary outcome was the development of early-onset pre-eclampsia (&lt;34 weeks). Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of platelet parameters. Results: The prevalence of early-onset pre-eclampsia was 5.3%. Women who developed early-onset pre-eclampsia had significantly higher MPV and PDW and lower PC at 14–18 weeks compared to those who remained normotensive. The combination of MPV &gt; 10.2 fL, PDW &gt; 16.5 fL, and PC &lt; 180 × 103/µL had the highest predictive value (AUC: 0.951, sensitivity: 71.1%, specificity: 99.1%). Individual platelet parameters also demonstrated good predictive ability. Conclusion: Platelet parameters, particularly MPV, PDW, and PC, measured at 14–18 weeks of gestation, have good predictive value for early-onset pre-eclampsia. Incorporating these parameters into routine antenatal screening could improve the early identification of at-risk women. Further research is needed to validate these findings and evaluate the cost-effectiveness of implementation.

Evaluate the Effectiveness of Nursing Interventional Package Regarding Pregnancy Induced Hypertension among Pregnant Women: A Pilot Study

Introduction: Pregnancy-induced hypertension (PIH) represents a significant public health concern, affecting a considerable proportion of pregnant women globally. The condition encompasses a range of hypertensive disorders, including gestational hypertension and preeclampsia, which can lead to severe maternal and neonatal complications if not effectively managed. The role of nursing interventions in addressing PIH is critical, as nurses are often the primary healthcare providers who interact with pregnant women throughout their prenatal care.Aim: To evaluate the effectiveness of nursing interventional package regarding pregnancy induced hypertension among pregnant women in selected hospitals, Chennai.Methods: The study used a quantitative, experimental research design conducted at Chinna Porur, PHC. The sample consisted of 40 pregnant women with hypertension, selected using a purposive sampling technique. Researchers collected data through a structured questionnaire capturing demographic and clinical characteristics. They also conducted a baseline assessment of Pregnancy-Induced Hypertension using the PIH Assessment Scale to evaluate participants' initial status. Data was analyzed using descriptive and inferential statistics, employing SPSS version 26.Results: The study revealed showed statistically significant improvements after the nursing intervention. The mean pretest score decreased from (16.48 ± 20.78 to 9.78 ± 8.92) in the posttest, with a significant difference based on the paired t-test analysis. These findings suggest the intervention had a positive and statistically significant effect on reducing the severity of pregnancy-induced hypertension symptoms among the participants.Conclusions: The study concluded that nursing intervention packages in managing pregnancy-induced hypertension was effective. These interventions have demonstrated improvements in patients' knowledge, psychological well-being, and clinical outcomes.

Incidence, and maternal and neonatal outcomes following pregnancy-associated colorectal cancer: A population-based linked data study.

The study aimed to describe the incidence of pregnancy-associated colorectal cancer (PACRC) in New South Wales (NSW), Australia, and to examine the perinatal outcomes of women with PACRC and their babies. A population-based cohort study was conducted using linked data from NSW. The study group comprised all women diagnosed with colorectal cancer during pregnancy (gestational CRC) or postpartum (postpartum CRC). Women who gave birth without cancer during pregnancy or postpartum formed the comparison group (no-cancer group). A total of 123 women were diagnosed with PACRC (22 gestational, 101 postpartum), and 1 786 078 women were in the no-cancer group. The incidence of PACRC was 6.9/100 000 women giving birth. From 1994 to 2013, the incidence significantly increased even when adjusting for maternal age (adjusted increase of 5.8% per year). Women with gestational CRC had significantly higher odds of severe maternal complications (AOR 29.27, 95% CI: 11.18-76.63) and were more likely to give birth by labor induction or no-labor caesarean section (AOR 4.39, 95% CI: 1.50-12.84) than women in the no-cancer group. Although babies born to women with gestational CRC did not experience congenital anomalies, they had higher odds of planned preterm birth (AOR 9.91, 95% CI: 1.99-49.21) and severe neonatal adverse outcomes (AOR 8.65, CI: 3.65-20.5) than babies of women without cancer. The study found a significant increase in PACRC incidence in NSW over the study period, independent of maternal age. Increased interventions during gestational CRC births reflect management challenges with higher maternal and neonatal morbidities.

Strategies for Coping with Hemolysis in Pregnancy for Sickle Cell Anemia: A Review

Sickle cell anemia (SCA) is a genetic disorder that poses significant challenges during pregnancy, primarily due to increased hemolysis caused by the physiological demands of pregnancy. Hemolysis, the destruction of red blood cells, exacerbates anemia and can lead to severe maternal and fetal complications, including preterm birth, growth restriction, and increased maternal morbidity. Effective strategies for coping with hemolysis during pregnancy in SCA are crucial for improving outcomes for both mother and baby. This review highlights key strategies for managing hemolysis in pregnant women with SCA, including transfusion therapy, pharmacological interventions, and nutritional support. Transfusion therapy, especially exchange transfusions, can effectively reduce the proportion of sickled red cells, improving oxygen delivery and minimizing hemolysis. Pharmacological interventions like hydroxyurea, traditionally avoided in pregnancy, are being reconsidered for their potential benefits, while antioxidant therapy and folic acid supplementation are crucial in reducing oxidative stress and supporting red blood cell production.

Maternal Complications After Laser Surgery for Twin-to-Twin Transfusion Syndrome, a Cohort Study.

To assess maternal complications after fetoscopic laser surgery (FLS) for the twin-to-twin transfusion syndrome (TTTS). All consecutive cases treated with FLS for TTTS between 2008 and 2021 at the Leiden University Medical Center (LUMC) were included. We allocated complications in three timeframes: "Admission for laser surgery," "pregnancy after laser," and "delivery and third stage of labor." Maternal complications were graded according to the Maternal and Fetal Adverse Event Terminology (MFAET) and for intra-abdominal hemorrhage, the Common Terminology Criteria for Adverse Events (CTCAE). In the study period, 637 mothers were treated for TTTS with FLS. There were 1559 occurrences of maternal complications. The rate of severe maternal complications (grade 3 or 4) was 8.0%. Severe complications consisted of six cases of severe intra-abdominal hemorrhage, nine cases of severe hemorrhage in pregnancy, one with severe chorioamnionitis, 10 with severe preeclampsia/HELLP syndrome, and 25 with a severe postpartum hemorrhage. Even though it is the gold standard for treating TTTS, FLS comes at a risk to the mother which should not be neglected. And even though not all complications have serious consequences to the mother, the severe maternal complication rate of 8.0% should be added to the inherent risks for the fetus, and should be discussed with patients eligible for surgery in order to make an informed decision on treatment options.

Advances in Thromboprophylaxis for High-Risk Pregnancies: A Comprehensive Review of Current Strategies and Emerging Approaches.

Thrombosis during pregnancy poses a significant clinical challenge due to its potential for severe maternal and fetal complications. The incidence of thromboembolic events in pregnant women is heightened by pregnancy-associated hypercoagulability, venous stasis, and endothelial changes, all of which contribute to an elevated risk. Effective thromboprophylaxis is essential to mitigate these risks and improve outcomes for both mother and child. This review provides a comprehensive evaluation of current thromboprophylaxis strategies, including pharmacologic interventions such as low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) and nonpharmacologic measures like compression stockings and lifestyle modifications. Additionally, the review explores emerging approaches, including personalized medicine strategies, novel anticoagulants, and technology-enabled monitoring solutions. By integrating current evidence with emerging trends, this review aims to offer insights into optimizing thromboprophylaxis in high-risk pregnancies, ultimately contributing to improved clinical outcomes and guiding future research directions in this critical area of maternal healthcare.

Role of Uterine Artery Doppler Study Between 11 and 14 Weeks as a Predictor of Preeclampsia.

Introduction Preeclampsia is a serious complication marked by antepartum hemorrhage, resulting in severe maternal and fetal complications. Predicting this condition using placental dysfunction assessments, such as uterine artery Doppler ultrasound, is challenging due to the placenta's evolving structural and biochemical characteristics throughout different stages of pregnancy. Objectives To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the uterine artery Doppler Pulsatility Index (PI) and Resistive Index (RI) in predicting preeclampsia. To compare the Doppler ultrasound measurements between normal pregnancies and those that develop preeclampsia. To assess the diagnostic accuracy of uterine artery Doppler ultrasound in predicting gestational hypertension in addition to preeclampsia. Methodology Conducted as a prospective study, 116 antenatal mothers with computed gestational ages and scan gestational ages between 11 and 14 weeks, and a previous history of preeclampsia were included. Subjects with chronic hypertension or multiple gestations were excluded. Participants underwent uterine artery Doppler screening, during which the PI and RI were measured upon obtaining three consecutive similar waveforms, and the mean PI of the left and right arteries was calculated. The outcomes of patients with normal pregnancies and those who developed preeclampsia were compared. Data were entered into Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA). Results The mean PI among participants was 1.75 (±0.38), with a range from 1 to 2.75. The mean RI was 0.58 (±0.08), ranging from 0.45 to 0.8. The cutoff for the mean PI in predicting preeclampsia was 2.27, which showed a sensitivity of 92.9%, specificity of 97.1%, PPV of 81.47%, NPV of 99.01%, and a diagnostic accuracy of 96.59% (area under the curve (AUC): 0.982). The cutoff for the mean RI for predicting preeclampsia was 0.695, with a sensitivity of 85.7%, specificity of 98%, PPV of 85.47%, NPV of 98.04%, and diagnostic accuracy of 96.52% (AUC: 0.965). In predicting gestational hypertension, the cutoff for the mean PI was 1.975, with a sensitivity of 80%, specificity of 82.9%, PPV of 17.41%, NPV of 98.92%, and diagnostic accuracy of 82.78% (AUC: 0.848). The cutoff for the mean RI in predicting gestational hypertension was 0.615, showing a sensitivity of 80%, specificity of 80.2%, PPV of 15.4%, NPV of 98.89%, and diagnostic accuracy of 80.19% (AUC: 0.767). Conclusion The research demonstrated that aberrant readings in uterine Doppler ultrasound, specifically in the PI and RI, possess strong overall validity in forecasting the occurrence of preeclampsia.

Clinical Characteristics and Maternal and Neonatal Outcomes of Pregnant Women Positive, Negative, and Recovered With COVID-19 Pneumonia

Background: The pandemic of coronavirus disease 2019 (COVID-19) has caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant Hispanic women with COVID-19. Methods: This study was a retrospective chart review. This cohort included pregnant females between the ages of 18-60 who had tested positive for COVID-19 and tested negative for COVID-19 from the electronic medical records of Texas Tech Health Sciences Department of OB/GYN clinics, University Medical Center (UMC), and El Paso Children’s Hospital (EPCH) from March 2020 to June 2021, in addition to their neonates. Records were analyzed to collect information on demographics, BMI, gestational age, COVID status at the time of delivery, history of exposure to COVID, signs and symptoms of COVID, presenting symptoms, comorbidities, and treatment of COVID before and after delivery. Further, mode of delivery, pregnancy complications, complications during labor, and adverse outcomes (maternal death, admission to ICU, length of stay in ICU). We also collected diagnostic data. The control group included age-matched pregnant individuals without a diagnosis of COVID. The control group was evaluated for the same variables and outcome assessment. For the neonatal outcomes, the mothers were matched to the neonate. Data collected on neonatal outcomes included demographics, date of delivery, APGAR score, admission to the newborn nursery or NICU, the reason for NICU admission, birthweight, length, head circumference, fetal abnormalities, prematurity, neonatal death, COVID test results, breastfeeding (expressed or direct), and length of hospital stay. We also collected diagnostic data for neonates. Statistical analyses was performed using descriptive statistics for the various variables, a t-test to determine differences between the two groups for the continuous variables, and a chi-square test for the categorical variables. Results: During the period March 21, 2020 - June 15, 2021, 370 pregnant women, out of which 100 women were COVID-positive, 71 women who were recovered, and 188 controls. COVID-positive women had more elevated fibrinogen, WBC, alkaline phosphatase, aspartate aminotransferase, and alanine transaminase but nonsignificant CRP levels. Most of the COVID-positive and COVID recovered women had preeclampsia during pregnancy, 29.24% COVID positive women delivered via C-section, while 68.42% of women delivered vaginally. The mean length of stay was 2.97 days for both groups. There 79.41% of women chose to breastfeed. One maternal death was recorded, while only two women had ICU admissions. Compared to the COVID-positive, the recovered women still had significantly elevated fibrinogen but not ALP, ALT, AST, and CRP. The COVID recovered women had lower counts of vaginal delivery (56.3%) and higher C-section rates (39.4%) among the three groups. The recovered group had higher premature deliveries (18%) than the other two groups (8%, 17%). Among the neonatal outcomes, there were four neonatal deaths in the COVID group, two neonates had COVID transmission during delivery, and 19.4 % of neonates were admitted to the NICU. Among neonatal vitals, blood pressure was higher in the positive (41%) and recovered (32.39%) groups than in controls (27.6%). Neonatal hypoglycemia was also higher in the recovered group (27.5%) than in the positive (17.11%) and control group (18.4%). Conclusions: Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had a vaginal or cesarean delivery. There were complications observed in women who recovered from COVID during pregnancy.

Comparison of Utero-Placental Perfusion Development From First to Second Trimester Between Low-Risk and High-Risk Pre-eclampsia Groups With Aspirin Prophylaxis.

Introduction Pre-eclampsia (PE) is a common diagnosis in pregnancy and affects pregnancies worldwide. Early-onset PE often leads to severe maternal and fetal complications. Prophylactic use of aspirin (150 mg/day) before the 16th week of pregnancy can reduce the risk of PE. This study aimed to investigate the effects of maternal factors on the development of uteroplacental perfusion and fetal biometry from the first to the second trimester in a risk group receiving aspirin prophylaxis compared to a control group without Aspirin. Methods This case-control study included 448 women at high risk for PE (risk group, RG) receiving aspirin prophylaxis and 468 women at low PE risk without aspirin intake (control group, CG). Parameters recorded and considered in the first (T1) and second (T2) trimesters included uterine artery pulsatility multiple of the median (UtAPI MoM), notching at T1 and T2 and fetal biometry parameters at T2. Maternal factors were also captured, and their respective effects were examined. Results UtAPI MoM at T1 and T2 showed a significant positive correlation (r = 0.39, p < 0.001), with UtAPI MoM at T2 significantly higher for notching "yes" at T1. Pre-existing arterial hypertension and UtAPI development demonstrated a significant association (p = 0.006). Women without this risk factor showed a significantly (p < 0.001) greater decline in UtAPI development. The likelihood of notching "yes" at T2 (p < 0.001; OR: 5.80) was increased with higher UtAPI MoM at T1. The mean values (T1 and T2) of UtAPI MoM were significantly higher in the risk group than in the control group. Patients in the risk group exhibited notching at T2 (p < 0.001; OR: 5.64) more often compared to the control group. The 95% CI of the estimated fetal weight for notching "yes" at T1 was below the 50th percentile. Gestational age and head circumference/abdomen circumference (HC/AC) ratio showed a significant negative correlation (p < 0.001; b = -0.01). The control group showed significantly higher estimated fetal weights than the risk group. The HC/AC ratio in the risk group was above the HC/AC ratio in the control group but without proving significance. Conclusions Persistent notching and elevated UtAPI MoMlevels in the second trimester may be risk factors for early-onset PE. Women with pre-existing arterial hypertension, notching and elevated UtAPI MoMvalues ​​in the first and second trimesters require special monitoring during the course of pregnancy.

Metabolomic prediction of severe maternal and newborn complications in preeclampsia

IntroductionPreeclampsia (PreE) remains a major source of maternal and newborn complications. Prenatal prediction of these complications could significantly improve pregnancy management.ObjectivesUsing metabolomic analysis we investigated the prenatal prediction of maternal and newborn complications in early and late PreE and investigated the pathogenesis of such complications.MethodsSerum samples from 76 cases of PreE (36 early-onset and 40 late-onset), and 40 unaffected controls were collected. Direct Injection Liquid Chromatography–Mass Spectrometry combined with Nuclear Magnetic Resonance (NMR) spectroscopy was performed. Logistic regression analysis was used to generate models for prediction of adverse maternal and neonatal outcomes in patients with PreE. Metabolite set enrichment analysis (MSEA) was used to identify the most dysregulated metabolites and pathways in PreE.ResultsForty-three metabolites were significantly altered (p < 0.05) in PreE cases with maternal complications and 162 metabolites were altered in PreE cases with newborn adverse outcomes. The top metabolite prediction model achieved an area under the receiver operating characteristic curve (AUC) = 0.806 (0.660–0.952) for predicting adverse maternal outcomes in early-onset PreE, while the AUC for late-onset PreE was 0.843 (0.712–0.974). For the prediction of adverse newborn outcomes, regression models achieved an AUC = 0.828 (0.674–0.982) in early-onset PreE and 0.911 (0.828–0.994) in late-onset PreE. Profound alterations of lipid metabolism were associated with adverse outcomes.ConclusionPrenatal metabolomic markers achieved robust prediction, superior to conventional markers for the prediction of adverse maternal and newborn outcomes in patients with PreE. We report for the first-time the prediction and metabolomic basis of adverse maternal and newborn outcomes in patients with PreE.

National registry of thoracoamniotic shunting using a double-basket catheter: A post-marketing surveillance registry of 295 patients with fetal hydrothorax.

We report on the 1-year outcomes of fetuses who underwent thoracoamniotic shunting (TAS) with a double-basket catheter for fetal hydrothorax (FHT) using a national post-marketing surveillance registry. This surveillance study was conducted for cases enrolled between 2011 and 2019. Preoperative, operative, and postoperative findings and outcomes had to be reported through the national surveillance website. Forty-three institutes enrolled 295 patients. In 60 patients, associated abnormalities were diagnosed after birth. Among the 235 patients with isolated hydrothorax, the survival rate at 1year of age was 70.5%. Among these patients, 89% did not require oxygen or other respiratory support. The 1-year survival rate in complicated cases was 27%. Trisomy 21 was the most common associated problem (40%). Catheter associated problems, including dislocation (25%), obstruction (24%), and preterm rupture of the membranes (6%) were observed, but there were no severe maternal complications. TAS before 29.5weeks of gestation (odds ratio [OR] 0.16) and skin edema and ascites (OR 0.06) were risk factors for death at one year, whereas appropriate shunt location for >28days (OR 4.2) was a protective factor. We report a favorable survival rate in fetuses with isolated FHT treated with this double-basket catheter.

Evaluation of Maternal and Perinatal Outcomes in Pregnancy with Preeclampsia at Aljala Maternity Hospital

Hypertensive disorders of pregnancy (HDP) accounts for 18% of maternal deaths worldwide, with an estimated number of about 62, 000–77, 000 deaths occur each year. The current study aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Aljala Maternity Hospital. A retrospective, descriptive, case series analysis for four hundred patients was done on the outcome of hypertensive disorder among pregnant women who admitted and were managed at Aljala teaching hospital with preeclampsia during the years 2019 and 2020. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally, delivery route, indications of cesarean section, fetal and maternal complications were determined. The current finding reported high prevalence of perinatal and maternal mortality among pregnant women with preeclampsia. Moreover, other severe maternal and perinatal complications such as Hemolysis Elevated Liver Enzyme Platelet (HELLP) syndrome, placental abruption, eclamptic fits, as well as low birth weight were also commonly reported. The current study showed early onset of preeclampsia was associated with increased risk of developing adverse maternal-fetal/neonatal outcomes compared to late-onset after 36 weeks. Our findings call for special consideration and close surveillance of those women with early-onset diseases.

Placenta percreta in first trimester – A rarity and diagnostic dilemma

The diagnosis of placenta accreta spectrum (PAS) in pregnancy is associated with severe maternal complications and is potentially life threatening. Moreover, PAS is difficult to diagnose in the first trimester, and the accuracy is low. A prenatal diagnosis is pivotal for planning an optimal management in PAS. A first trimester US(Ultrasound) can detect PAS in good proportion of cases, although the sensitivity is lower than a second or third trimester US. An early first trimester US can further help predict severity of PAS and its surgical outcome. As the management and diagnosis remains a challenge as far as PAS in early pregnancy is concerned, a high clinical suspicion especially in cases of previous uterine scar and bleeding following a surgical evacuation cannot be overemphasised. We report a case of Placenta Percreta in First Trimester, its rarity and diagnostic dilemma.

Pregnancy and cardiac maternal outcomes in women with inherited cardiomyopathy: interest of the CARPREG II risk score.

Inherited cardiomyopathies are relatively rare but carry a high risk of cardiac maternal morbidity and mortality during pregnancy and postpartum. However, data for risk stratification are scarce. The new CARPREG II score improves prediction of prognosis in pregnancies associated with heart disease, though its role in inherited cardiomyopathies is unclear. We aim to describe characteristics and cardiac maternal outcomes in patients with inherited cardiomyopathy during pregnancy, and to evaluate the interest of the CARPREG II risk score in this population. In this retrospective single-centre study, 90 consecutive pregnancies in 74 patients were included (mean age 32±5years), including 28 cases of dilated cardiomyopathy (DCM), 46 of hypertrophic cardiomyopathy, 11 of arrhythmogenic right ventricular cardiomyopathy and 5 of left ventricular noncompaction, excluding peripartum cardiomyopathy. The discriminatory power of several risk scores was assessed by the area under the receiver-operating characteristic curve (AUC). Median CARPREG II score was 2 [0;3] and was higher in the DCM subgroup. A severe cardiac maternal complication was observed in 18 (20%) pregnancies, mainly driven by arrhythmia and heart failure (each event in 10 pregnancies), with 3 cardiovascular deaths. Forty-three pregnancies (48%) presented foetal/neonatal complications (18 premature delivery, 3 foetal/neonatal death). CARPREG II was significantly associated with cardiac maternal complications (P<0.05 for all) and showed a higher AUC (0.782) than CARPREG (0.755), mWHO (0.697) and ZAHARA (0.604). Pregnancy in women with inherited cardiomyopathy carries a high risk of maternal cardiovascular complications. CARPREG II is the most efficient predictor of cardiovascular complications in this population.

P-03 A report of recurring pregnancy-induced Cushing's Syndrome

Abstract Introduction The incidence of pregnancy-induced Cushing's syndrome (CS) is very low. However, the diagnosis of CS in pregnant patients is very difficult because of an overlapping signs and symptoms. Clinical Case A 20-year-old woman with polycystic ovarian syndrome (PCOS) was successfully treated with clomiphene for infertility and pregnant in September of 2016 for the first time. She experienced out of proportion abdominal obesity, excessive striosis, exacerbation of hirsutism and myasthenia during the first trimester of her pregnancy. Initial diagnosis of ovarian hyperstimulation syndrome (OHSS) was made and due to concomitant intrauterine growth retardation (IUGR), the pregnancy was electively terminated at the 8th week. All associated symptoms spontaneously regressed within 2-3 months after the abortion. The second pregnancy was induced with a pulse treatment of letrozole 5 mg, followed by 3 every other day injections of 100 units recombinant follicle-stimulating hormone. Within the first 4 weeks into the second pregnancy, the patient developed recurrence of OHSS symptoms. In addition to the prior symptoms and progressive proximal myasthenia, the patient developed hypertension, round moon-like face, back hump, and suprasternal fat pad consistent with the typical features of CS. In week 14 of pregnancy, the patient complained from acute-onset bilateral blindness and hypertension (blood pressure of 180/120 mmHg), which soon progressed into loss of consciousness and grand-mal seizure. She was admitted to the intensive care unit (ICU). Admission laboratory testing included those to assess the function of the pituitary-adrenal axis (HPA) due to the presence of symptoms related to CS. Based on available clinical information a diagnosis of hemolysis, elevated liver enzymes, and a low platelet count (HELLP) syndrome was made and emergency termination of pregnancy was carried out at the gestational age of 14 weeks. The patient`s clinical signs such as hypertension and acute blindness were totally subsided soon after the therapeutic abortion. Diagnosis of ACTH independent CS was made based on elevated 8 a.m. serum cortisol level unresponsive to low-dose dexamethasone (45-41 µg/ dL). Conclusion Diagnosis of CS in pregnancy is challenging as the physiological changes during pregnancy may mimic those of CS. Long-term treatment of gestational CS has not been as successful. However, in the case of adrenal hyperplasia, bilateral adrenalectomy offers a certain cure. Our patient had a therapeutic abortion due to severe maternal complications and development of CS during the early gestational age. The patient was reeducated on the subject of contraception and the possibility of adrenalectomy for future pregnancies. Due to the temporal relation between the occurrence of CS after each pregnancy the diagnosis of gestational hypercortisolism was made, and for further pregnancies bilateral adrenalectomy was recommended.

Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study.

The African Surgical Outcomes Study (ASOS) found that maternal mortality following cesarean delivery in Africa is 50 times higher than in high-income countries, and associated with obstetric hemorrhage and anesthesia complications. Mothers who died were more likely to receive general anesthesia (GA). The associations between GA versus spinal anesthesia (SA) and preoperative risk factors, maternal anesthesia complications, and neonatal outcomes following cesarean delivery in Africa are unknown. This is a secondary explanatory analysis of 3792 patients undergoing cesarean delivery in ASOS, a prospective observational cohort study, across 22 African countries. The primary aim was to estimate the association between preoperative risk factors and the outcome of the method of anesthesia delivered. Secondary aims were to estimate the association between the method of anesthesia and the outcomes (1) maternal intraoperative hypotension, (2) severe maternal anesthesia complications, and (3) neonatal mortality. Generalized linear mixed models adjusting for obstetric gravidity and gestation, American Society of Anesthesiologists (ASA) category, urgency of surgery, maternal comorbidities, fetal distress, and level of anesthesia provider were used. Of 3709 patients, SA was performed in 2968 (80%) and GA in 741 (20%). Preoperative factors independently associated with GA for cesarean delivery were gestational age (adjusted odds ratio [aOR], 1.093; 95% confidence interval [CI], 1.052-1.135), ASA categories III (aOR, 11.84; 95% CI, 2.93-46.31) and IV (aOR, 11.48; 95% CI, 2.93-44.93), eclampsia (aOR, 3.92; 95% CI, 2.18-7.06), placental abruption (aOR, 6.23; 95% CI, 3.36-11.54), and ruptured uterus (aOR, 3.61; 95% CI, 1.36-9.63). SA was administered to 48 of 94 (51.1%) patients with eclampsia, 12 of 28 (42.9%) with cardiac disease, 14 of 19 (73.7%) with preoperative sepsis, 48 of 76 (63.2%) with antepartum hemorrhage, 30 of 55 (54.5%) with placenta previa, 33 of 78 (42.3%) with placental abruption, and 12 of 29 (41.4%) with a ruptured uterus. The composite maternal outcome "all anesthesia complications" was more frequent in GA than SA (9/741 [1.2%] vs 3/2968 [0.1%], P < .001). The unadjusted neonatal mortality was higher with GA than SA (65/662 [9.8%] vs 73/2669 [2.7%], P < .001). The adjusted analyses demonstrated no association between method of anesthesia and (1) intraoperative maternal hypotension and (2) neonatal mortality. Analysis of patients undergoing anesthesia for cesarean delivery in Africa indicated patients more likely to receive GA. Anesthesia complications and neonatal mortality were more frequent following GA. SA was often administered to high-risk patients, including those with eclampsia or obstetric hemorrhage. Training in the principles of selection of method of anesthesia, and the skills of safe GA and neonatal resuscitation, is recommended.

Neonatal Complications in Mothers with Severe Complications or Near-Miss Cases

Background: Maternal complications, particularly maternal near death, may also contribute to the increase in perinatal complications. Consequently, this study investigated the correlation between neonatal complications in mothers with severe pregnancy complications and near-miss cases. Methods: This cross-sectional study was conducted on mothers who gave birth between March 2017 and March 2019 at a Medical Training Hospital and a Private Hospital in Tehran and experienced severe maternal complications or life-threatening conditions. The characteristics of mothers and infants were recorded. Statistical tests were employed to analyze the data (p˂0.05). Resulting: This study evaluated 138 mothers with severe complications, where 32.6% exhibited near-death conditions. The most common causes of severe maternal outcomes were preeclampsia and severe bleeding (50.7% and 36.2%, respectively). Of newborn 48.2% experienced prematurity, 35.6% had low birth weight. 59.9% of the newborns of the mothers who were studied experienced at least one complication. 61.9% infants had respiratory failure, and 14.2% had a severe infection. The neonate mortality rate was 3%, while the stillbirth rate was 3.6%. Although linear/ binomial logistic regression test was not showed the correlation between the mother’s demographic characteristics and perinatal complications but one third of mothers with the underlying disease had neonatal complications and the likelihood of prenatal complications is higher in multiparous women over 30. Conclusion: In severe maternal complications, neonatal complications, prematurity and low birth weight, are more prevalent. Consequently, it appears necessary to equip hospitals with intensive care units and trained personnel who can provide adequate support for mothers and infants.

Isolation and Susceptibility of Microorganisms Responsible for Asymptomatic Antenatal Bacteriuria

Aim &amp; Objective: Determination of prevalence, bacterial profile and antibiotic sensitivity of microorganisms responsible for asymptomatic UTI during pregnancy.&#x0D; Methodology: The type of study is cross-sectional, Prospective type, was conducted at the PUMHS for Women Nawabshah (SBA) after approval from the Ethical Review Committee and the duration was 2 years from 1st Jan 2021-31st Dec 2022. Samples were collected by non-probability- convenient method from all pregnant women without any clinical complaints attending the Outpatient Department of Gynecology and Obstetrics PUMHS Hospital Nawabshah. The midstream urine collected by clean catch method in sterile containers was processed for DR of urine including physical, chemical, and microscopic examination. After the urine detailed report, the samples were sent for, culture by using the following media, blood, Macconkey’s, and CLED agar. Growth-positive samples were proceeding for gram staining, biochemical tests, and antibiotic sensitivity reports according to world standard methods for confirmation.&#x0D; Results: Out of 477 patients 96 (20%) were positive for ASB, with the mean age of the patient being 29.32±5.74 The most common microorganisms found in the study were E.coli 67 (69.7.%), followed by Klebisella in 4(4%), proteus 9(9%), pseudomonas 8(8.3%), staphylococcus aureus 2(2%), staphylococcus saprophyticus in 4(4%), streptococcus pyogen 2(2%).&#x0D; There was 100% sensitivity found for all isolated microorganisms following culture examination to following antibiotics: Ciprofloxacin, Cefuroxime, Imepenem, Ceftriaxone Amikacin, Meropenem, and Piperacillin-tazobactam; however, 52% and 45% sensitivity of E.coli and 100% sensitivity of streptococci were present for amoxicillin-clavulanic acid and ampicillin respectively.&#x0D; Conclusion: A rising number of silent antenatal bacteriuria was observed in younger age women with severe maternal and fetal complications in advanced stages of pregnancy and thereafter. It is therefore suggested to routinely perform urine cultures for every suspected pregnant lady during advanced antenatal visits to diagnose and properly treat the asymptomatic bacteriuria in terms of avoiding antibiotic resistance and materno-fetal complications in the near future.

Ranked severe maternal morbidity index for population-level surveillance at delivery hospitalization based on hospital discharge data.

Severe maternal morbidity (SMM) is broadly defined as an unexpected and potentially life-threatening event associated with labor and delivery. The Centers for Disease Control and Prevention (CDC) produced 21 different indicators based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) hospital diagnostic and procedure codes to identify cases of SMM. To examine existing SMM indicators and determine which indicators identified the most in-hospital mortality at delivery hospitalization. Data from the 1993-2015 and 2017-2019 Healthcare Cost and Utilization Project's National Inpatient Sample were used to report SMM indicator-specific prevalences, in-hospital mortality rates, and population attributable fractions (PAF) of mortality. We hierarchically ranked indicators by their overall PAF of in-hospital mortality. Predictive modeling determined if SMM prevalence remained comparable after transition to ICD-10-CM coding. The study population consisted of 18,198,934 hospitalizations representing 87,864,173 US delivery hospitalizations. The 15 top ranked indicators identified 80% of in-hospital mortality; the proportion identified by the remaining indicators was negligible (2%). The top 15 indicators were: restoration of cardiac rhythm; cardiac arrest; mechanical ventilation; tracheostomy; amniotic fluid embolism; aneurysm; acute respiratory distress syndrome; acute myocardial infarction; shock; thromboembolism, pulmonary embolism; cerebrovascular disorders; sepsis; both DIC and blood transfusion; acute renal failure; and hysterectomy. The overall prevalence of the top 15 ranked SMM indicators (~22,000 SMM cases per year) was comparable after transition to ICD-10-CM coding. We determined the 15 indicators that identified the most in-hospital mortality at delivery hospitalization in the US. Continued testing of SMM indicators can improve measurement and surveillance of the most severe maternal complications at the population level.