Severe Maternal Outcomes Research Articles

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.

Abortion-related morbidity in six Latin American and Caribbean countries: findings of the WHO/HRP multi-country survey on abortion (MCS-A)

IntroductionAbortion-related complications are a significant cause of morbidity and mortality among women in many Latin American and Caribbean (LAC) countries. The objective of this study was to characterise abortion-related complication...

Surviving maternal sepsis in low-income countries

Maternal sepsis accounts for 11% of maternal deaths globally, making it the third leading cause of maternal mortality in the world, after haemorrhage and hypertension.1 A key finding from the Global Maternal Sepsis (GLOSS) substudy2 was that women in low-income countries who were admitted during the post-partum or post-abortion period were more likely to have a severe maternal outcome than women in upper-middle-income or high-income countries (adjusted odds ratio 1·84 [95% CI 1·05–3·22]). However, no other facility characteristics were associated with increased odds of severe maternal outcomes; most of these outcomes were associated with individual characteristics, such as pre-eclampsia.

Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study: a cross-sectional study

SummaryBackgroundInfections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes.MethodsGLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes.FindingsWe included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05–3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02–5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities).InterpretationWhile health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes.FundingUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development.

New obstetric systemic inflammatory response syndrome criteria for early identification of high-risk of sepsis in obstetric patients.

We aimed to establish new cut-off values for SIRS (Systemic Inflammatory Response Syndrome) variables in the obstetric population. A prospective cohort study in pregnant and postpartum women admitted with systemic infections between December 2017 and January 2019. Patients were divided into three cohorts: Group A, patients with infection but without severe maternal outcomes (SMO); Group B, patients with infection and SMO or admission to the intensive care unit (ICU); and Group C, a control group. Outcome measures were ICU admission and SMO. The relationship between SIRS criteria and SMO was expressed as the area under the receiver operating characteristics curve (AUROC), selecting the best cut-off for each SIRS criterion. A total of 541 obstetric patients were enrolled, including 341 with infections and 200 enrolled as the reference group (Group C). The patients with infections included 313 (91.7%) in Group A and 28 (8.2%) in Group B. There were significant differences for all SIRS variables in Group B, compared with Groups A and C, but there were no significant differences between Groups A and C. The best cut-off values were the following: temperature 38.2°C, OR 4.1 (1.8-9.0); heart rate 120bpm, OR 2.9 (1.2-7.4); respiratory rate 22bpm, OR 4.1 (1.6-10.1); and leukocyte count 16,100 per mcl, OR 3.5 (1.6-7.6). The cut-off values for SIRS variables did not differ between healthy and infected obstetric patients. However, a higher cut-off may help predict the population with a higher risk of severe maternal outcomes.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in pregnancy – An overview

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-1) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections, like most other viruses that affect the respiratory tract can cause severe maternal illness and adverse pregnancy outcomes. They are not only highly transmissible (acquired through droplets), but Host reservoirs such as dromedary camels for MERS-CoV and masked palm civet for SARS-CoV-1 are critical links in the onset of outbreaks. Clinically they present with flu-like symptoms and therefore a high index of suspicion is required to ensure timely diagnosis and tailored management. Although there are not many reported series on these infections in pregnancy they seem to be associated with an increased risk of preterm delivery and maternal mortality. Diagnosis is made by PCR from nasopharyngeal swabs. There are currently no effective anti-viral agents for these viruses but following infections various agents have been administered to patients. The most important aspect of management should be early identification of deterioration and intensive support and prevention of transmission. Our understanding of the evidence of the impact of both infections on pregnancies suggests the potential for future repeat outbreaks, hence the importance of maintaining vigilance across healthcare systems.

Great saves or near misses? Severe maternal outcome in Metro East, South Africa: A region-wide population-based case-control study.

ObjectiveTo assess the incidence of severe maternal outcome (SMO), comprising maternal mortality (MM) and maternal near miss (MNM), in Metro East health district, Western Cape Province, South Africa between November 2014 and November 2015 and to identify associated determinants leading to SMO with the aim to improve maternity care.MethodsRegion‐wide population‐based case‐control study. Women were included in the study, if they were maternal deaths or met MNM criteria, both as defined by WHO. Characteristics of women with SMO were compared with those of a sample of women without SMO, matched for age and parity, taken from midwifery‐led obstetrical units from two residential areas in Metro East, using multivariate regression analysis.ResultsIncidence of SMO was 9.1 per 1000 live births, and incidence of MNM was 8.6 per 1000 live births. Main causes of SMO were obstetrical hemorrhage and hypertensive disorders. Factors associated with SMO were HIV (adjusted odds ratio [aOR] 24.8; 95% confidence interval [CI] 10.0–61.6), pre‐eclampsia (aOR 17.5; 95% CI 7.9–38.7), birth by cesarean section (aOR 8.4; 95% CI 5.8–12.3), and chronic hypertension (aOR 2.4; 95% CI 1.1–5.1).ConclusionEvaluation of SMO incidence and associated determinants supports optimizing tailored guidelines in Metro‐East health district to improve maternal health.

Cost-effectiveness analysis of a quality improvement program to reduce caesarean sections in Brazilian private hospitals: a case study

BackgroundIn 2015, a quality improvement project of childbirth care called Adequate Childbirth Project (“Projeto Parto Adequado”- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce caesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital—the model following the recommendations of the PPA and the standard of care model—in reducing the proportion of caesarean sections.MethodsWe conducted a cost-effectiveness analysis using data from one of the private hospitals included in the PPA project. The main outcome was the proportion of caesarean section. We used total cost of hospitalization for women and newborns, from the health care sector perspective, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of caesarean section and of maternal and neonatal complications.Results238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the caesarean section probability (88.6% vs 31.7%, p < 0.001) with an incremental cost-effectiveness ratio of US$1,237.40 per avoided caesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal near miss. The cost of uncomplicated vaginal births and caesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care.ConclusionThe PPA model of care was cost-effective in reducing caesarean sections in women assisted in a Brazilian private hospital. Moreover, it reduced the frequency of early term births and did not increase the occurrence of severe negative maternal and neonatal outcomes.

Opportunities for early diagnostics of contemporary obstetric sepsis

Aim: to objectively assess potential for early generalized postpartum infection diagnostics prior to the onset of irreversible organ changes based on a retrospective analysis.Materials and Methods. Сlinical and laboratory forensic medical data were examined by analysing 29 cases of severe maternal outcomes coupled to sepsis: including 17 «near miss» and 12 deceased patients (maternal mortality). The control group consisted of 30 patients who had chorioamnionitis in labor and successfully completed pregnancy. Statistical data analysis was carried out by using nonparametric statistics by creating conjugacy tables and assessing a relationship between parameters with Pearson χ2 distribution.Results. There were found significant differences in rate of some symptoms in both groups. Patients with severe maternal outcomes vs. control group were significantly more likely to develop hyperthermia ≥ 38.0 °C or hypothermia ≤ 36.0 °C, hectic fever, leukocytosis ≥ 12×109/L or leukopenia ≤ 4×109/L before the end of pregnancy; after pregnancy, persistent subfebrility, febrility or hypothermia, hectic fever, multiple-organ failure syndrome (PON), as well as uterine subinvolution and abnormal discharge from the genital tract were observed.Conclusion. Early identification of recognized symptoms of systemic inflammatory response syndrome and PON allows to properly assess severity of patient condition, taking into account the risk of generalized infection, contributes to making correct diagnosis and timely implementation of adequate organizational and therapeutic measures.

A STUDY OF NEAR MISS OBSTETRICAL EVENTS AT A TERTIARY CARE CENTRE AT MADHYA PRADESH

Background: Maternal mortality is the major indicator used to monitor maternal health. For every women, who dies, however, many suffer serious life threatening complications of pregnancy. Yet relatively little attention has been given to identifying a general category of morbidities that could be called near misses. Characterising near miss morbidity is valuable for monitoring the quality of hospital based case and for assessing incidence of life-threatening complications. Besides mortality data, the identication and accurate documentation of "near-miss" morbidity (a more sensitive index) is extremely important to assess the quality of health care systems. It can suitably guide to adopt appropriate measures to reduce maternal mortality and morbidity. Methods: A cross sectional observational study was conducted in department of obstetrics and gynecology, MGM medical college Indore (M.P.) over apeiod of 2 years. Out of all obstetric inpatients cases of near miss were taken, identied by WHO 2009 criteria. In all cases the demographic characteristics, frequency of near miss in each criteria, direct and indirect obstetric causes of maternal morbidity &amp; mortality were noted .This study was approved by institutional ethical committee. The data was recorded in predesign coded case report form and statistical analysis was performed using the STATA12.1. Result: in the present study incidence of Near miss was 65.6, Maternal mortality ratio=558(2017) 590(2018) per 1 lakh live birth and Near miss to maternal death ratio was 11.4 Severe maternal outcome ratio=71.3 per 1000 live birth Conclusion: Maternal near miss reviews provide evidence of where the main problem in overcoming maternal mortality and morbidity may lie, and analysis can be done in practical terms and highlight the key areas requiring recommendations for health sector and community action as well as guidelines for improving clinical outcomes.

Downregulated ribosomal protein L39 inhibits trophoblast cell migration and invasion by targeting E-cadherin in the placenta of patients with preeclampsia.

Early-onset preeclampsia (PE) is a pregnancy complication that can lead to severe adverse maternal and fetal outcomes. However, the mechanisms underlying the development of early-onset PE are not fully understood. Ribosomal protein L39 (RPL39) is a member of the S39E family of ribosomal proteins that plays an important role in stem cell self-renewal, cancer metastasis, and chemoresistance. In this study, we aimed to explore the potential function of RPL39 in placental trophoblast cells. We analyzed the expression of RPL39 in early-onset PE and normal placental tissues using real-time PCR, western blot analysis, and immunohistochemistry. The results showed that RPL39 was markedly downregulated in early-onset PE placental tissues. RPL39 knockdown inhibited trophoblast cell proliferation, migration, and invasion, as well as placental explant outgrowth. Flow cytometry analysis suggested that knockdown of RPL39 resulted in cell cycle arrest at the G0/G1 phase, but had no significant effect on cell apoptosis. We also found that RPL39 knockdown could alter cell morphology. We then measured the expression of the epithelial cell marker E-cadherin following knockdown of RPL39 in Bewo and HTR8/SVneo cells. RPL39 knockdown increased the expression of E-cadherin. Furthermore, E-cadherin expression was upregulated in placental explant outgrowth tissues transfected with RPL39 small interfering RNA. In conclusion, RPL39 plays an essential role in proliferation, invasion, and migration of trophoblast cells by targeting E-cadherin. Our findings provide novel insight into the mechanisms underlying the occurrence of early-onset PE.

Comparison of Fetomaternal Outcome Between Planned Vaginal Delivery and Planned Cesarean Section in Women with Eclampsia: Observational Study.

The route of termination of pregnancy in eclampsia is not clearly established. This study aims to compare the fetomaternal outcome between planned vaginal delivery and planned cesarean section in women with eclampsia after 34weeks of gestation. This prospective observational study was conducted in the department of Obstetrics and Gynecology, Midnapore Medical College, West Bengal, India. 182 women with eclampsia carrying 34weeks or more gestation were allocated to either cesarean(CD) or vaginal delivery (VD) group. The primary measure of outcome was severe maternal outcome. Secondary measures of outcome were perinatal mortality and morbidity. Of the 62 women allocated in vaginal delivery (VD) group, 60 women (32.97%) had vaginal delivery and 122 (67.03%) had undergone cesarean delivery (CD). Severe maternal outcome was more common in VD group in comparison with CD group (72.5% vs 27.5%, P < 0.00001 RR 2.64 OR 6.98). Perinatal outcome in relation to Apgar score at 5min, still birth was better in CD group than VD group. Perinatal death was higher in VD group when compared with CD group (25.8%; vs. 8.33%; P = 0.002, RR 3.1 OR 3.83). There is increasing trend of delivering the eclampsia mother at > 34weeks of gestation by cesarean section instead of inducing labor and delivering vaginally. Cesarean section when chosen as method of delivery does not increase morbidity or mortality.

Wireless versus routine physiologic monitoring after cesarean delivery to reduce maternal morbidity and mortality in a resource-limited setting: protocol of type 2 hybrid effectiveness-implementation study

BackgroundWomen in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth globally. Despite increases in facility-based childbirth, gaps in quality of care at facilities have limited reductions in maternal deaths. Infrequent physiologic monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions for women experiencing complications.MethodsWe will conduct a type-2 hybrid effectiveness-implementation study over 12 months to evaluate using a wireless physiologic monitoring system to detect and alert clinicians of abnormal vital signs in women for 24 h after undergoing emergency cesarean delivery at a tertiary care facility in Uganda. We will provide physiologic data (heart rate, respiratory rate, temperature and blood pressure) to clinicians via a smartphone-based application with alert notifications if monitored women develop predefined abnormalities in monitored physiologic signs. We will alternate two-week intervention and control time periods where women and clinicians use the wireless monitoring system during intervention periods and current standard of care (i.e., manual vital sign measurement when clinically indicated) during control periods. Our primary outcome for effectiveness is a composite of severe maternal outcomes per World Health Organization criteria (e.g. death, cardiac arrest, jaundice, shock, prolonged unconsciousness, paralysis, hysterectomy). Secondary outcomes include maternal mortality rate, and case fatality rates for postpartum hemorrhage, hypertensive disorders, and sepsis. We will use the RE-AIM implementation framework to measure implementation metrics of the wireless physiologic system including Reach (proportion of eligible women monitored, length of time women monitored), Efficacy (proportion of women with monitoring according to Uganda Ministry of Health guidelines, number of appropriate alerts sent), Adoption (proportion of clinicians utilizing physiologic data per shift, clinical actions in response to alerts), Implementation (fidelity to monitoring protocol), Maintenance (sustainability of implementation over time). We will also perform in-depth qualitative interviews with up to 30 women and 30 clinicians participating in the study.DiscussionThis is the first hybrid-effectiveness study of wireless physiologic monitoring in an obstetric population. This study offers insights into use of wireless monitoring systems in low resource-settings, as well as normal and abnormal physiologic parameters among women delivering by cesarean.Trial registrationClinicalTrials.gov, NCT04060667. Registered on 08/01/2019.

316 Preeclampsia severity after spontaneous or IVF conception in women age 40 and over

Preeclampsia (PE) is more common in women who conceived by in vitro fertilization (IVF). However, it is unclear if PE severity is worse in IVF pregnancies as prior studies have not fully controlled for age and other confounding factors. We sought to determine if PE severity is worse in women age 40 and over with IVF compared to spontaneous conception. Cohort study of women age 40 and over, who had PE and delivered at our institution from 1/1/13 to 12/31/17. This cohort, chosen due to the high prevalence of IVF conception in women 40 and over, was identified using ICD-10 codes and chart validation. Exclusions were maternal age <40, fetal demise, and non-IVF fertility treatments. The primary exposure was IVF conception (vs. spontaneous) and the primary outcome was PE with severe features (vs. PE without severe features). Secondary outcomes included severe symptoms, laboratory measures, and adverse maternal outcomes (see footnote Table 2). Analyses by t-test, Chi-squared or Fisher’s exact test, and logistic regression (α=0.05). We identified 237 women age 40 and over with PE (mean 42±2 years); 138 (58%) conceived spontaneously and 99 (42%) conceived by IVF. Women with IVF pregnancy were more often older, nulliparous, White, with multifetal gestation and lower BMI (Table 1). Compared to women with spontaneous conception, those with IVF pregnancy were not more likely to have PE with severe features (90% vs. 82%, P=0.09) (Table 2). The odds of PE with severe features was not increased in IVF pregnancies even after adjustment for age, race, BMI, nulliparity and multifetal gestation (aOR 1.9, 95% CI 0.7-5.1). Adverse maternal outcomes were increased with IVF pregnancy (36% vs. 23%, P=0.03), but this was not significant after multivariable adjustment (aOR 0.64, 95% CI 0.3-1.4). In women 40 and over, IVF pregnancy was not independently associated with an increase in preeclampsia severity or adverse maternal outcomes. However, most women 40 and over had PE with severe features, suggesting that age may drive disease severity regardless of mode of conception.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1085 Maternal and neonatal outcomes of a subsequent pregnancy after stillbirth

Prior stillbirth is associated with increased risk of future stillbirth, but risks of adverse neonatal outcomes in a subsequent liveborn pregnancy are unknown. This is a secondary analysis of a large NIH-funded retrospective cohort study of women with diabetes, hypertensive disorders, and/or fetal growth restriction who delivered at a tertiary-care hospital from January 2002 to March 2013, excluding women with only severe preeclampsia or multifetal gestations. All women in the parent study were included in this analysis, comparing women with and without a history of stillbirth >20 weeks. The primary outcome is a neonatal morbidity composite: neonatal resuscitation (oxygen, CPAP, intubation, CPR), neonatal injury, RDS, TTN, hypoglycemia, sepsis. Secondary outcomes include a maternal morbidity composite (DVT/PE, ICU admission, DIC, sepsis, hysterectomy, pulmonary edema, renal failure, blood transfusion), neonatal death, and less severe neonatal and maternal outcomes. Log binomial and linear regression were performed controlling for maternal comorbidities. 191 women with and 11,725 women without prior stillbirth were included. Women with prior stillbirth were older (p<0.001), had higher BMI (p=0.001), and higher rates of chronic hypertension (p=0.007), autoimmune disease (p=0.02), and clotting disorder needing anticoagulation (p=0.03). After controlling for these factors, women with prior stillbirth had nearly 25% increased risk of composite neonatal morbidity (aRR 1.23; 95% CI 1.02-1.48), more than 50% increased risk of NICU admission (aRR 1.53; 95% CI 1.14-2.05), and nearly seven-fold increased risk of neonatal death (aRR 6.95; 95% CI 1.37-35.3), despite delivery at similar gestational age. Women with prior stillbirth were equally likely to have the maternal morbidity composite but nearly twice as likely to develop severe pre-eclampsia (aRR 1.88; 95% CI 1.09-3.31). Women with common obstetric comorbidities who have a prior stillbirth are at higher risk for severe neonatal complications, NICU admission and neonatal death when compared to women without prior stillbirth.

The first SARS-CoV-2 wave among pregnant women in Italy: results from a prospective population-based study.

This study aimed to estimate the incidence of SARS-CoV-2 infection among pregnant women during the first pandemic wave in Italy, and to describe COVID-19 disease characteristics and maternal and perinatal outcomes. National population-based prospective cohort study collecting information on women with SARS-CoV-2 diagnosis, confirmed within 7 days from hospital admission. The national SARS-CoV-2 rate was 6.04 per 1,000 births (95% CI 5.62-6.49) among pregnant women and 7.54 (95% CI 7.47-7.61) among women in reproductive age. 72.1% of the cohort developed mild COVID-19 disease without pneumonia nor need for ventilatory support. Severe disease was significantly associated with women's previous comorbidities (OR 2.55; 95% CI 0.98-6.90), obesity (OR 4.76; 95% CI 1.79-12.66) and citizenship from High Migration Pressure Countries (OR 3.43; 95% CI 1.27-9.25). During the first pandemic wave in Italy, the SARS-CoV-2 rate among pregnant women was lower compared to that detected among women of reproductive age, and risks of severe COVID-19 disease and adverse maternal and perinatal outcomes were rare.

Maternal Near-Miss as a Surrogate Indicator of the Quality of Obstetric Care: A Study in a Tertiary Care Hospital in Eastern India.

BackgroundMonitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health.Aim and objectiveThe objective of this study was to assess and analyze the incidence of maternal near-miss (MNM) and maternal death (MD) at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India.Material and methodThis study was a prospective observational study conducted at Tata Main Hospital from November 2016 to October 2019. The study population included all the pregnant women who fulfilled the WHO near-miss criteria based on organ dysfunction or failure and all the maternal deaths that occurred during the study period.ResultsDuring the study period, there were 15,377 deliveries and 14,636 live births. The MNM cases were 153, and 38 were maternal deaths. The maternal near-miss ratio (MNMR) and severe maternal outcome ratio (SMOR) were 19.9 and 13.1 per 1000 live births, respectively. The maternal near-miss to mortality ratio (MNM: 1 MD) was 4:1, and the mortality index (MI) was 19.9%. Haemorrhagic disorders were the leading cause (40.5%) of MNM, followed by hypertensive disorders (25.5%) and cardiac diseases (14.4%). Similarly, both haemorrhage (23.7%) and sepsis (23.7%) were the leading causes of death followed by hypertensive disorders (15.8%). On reviewing patients, 62% of near-miss and 92% of mortality cases had shown organ dysfunction on admission.ConclusionMNM and MD cases share similar pathology with a different outcome. Hence, monitoring a larger volume of MNM cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths.

Maternal and fetal outcome in placenta accreta spectrum (PAS) associated with placenta previa: a retrospective analysis from a tertiary center.

Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017–April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at <37 weeks of gestation, and the maternal outcome was uterine preservation. Among the 12 patients, the mean age was 34±3.44 years. All women had risk factors for abnormally invasive placenta, such as placenta previa or previous cesarean delivery. Most women underwent planned cesarean delivery at the mean gestational age of 36.4±0.9 weeks. In our study, the uterus was preserved in only one case (8.33%), and hysterectomy with preservation of ovaries was performed in the rest of the cases. Mean maternal blood loss during surgery was 2175±1440 ml. Severe maternal outcomes were recorded only in one case (8.33%). We identified a low uterine preservation rate and a good perinatal outcome. Conservative management should be reserved for fertility desire and extensive disease due to surgical difficulty. Early identification of the risk factors and strategic management may improve maternal and fetal outcomes.

Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries

IntroductionComplications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to...