OBJECTIVE:Uterine compression sutures (UCS) serve as a uterus-preserving option for the management of postpartum hemorrhage (PPH); however, the clinical characteristics associated with the need for additional treatment after UCS remain incompletely characterized. This study aimed to explore clinical factors associated with escalation to additional treatment after UCS. METHODS:We conducted a single-center retrospective cohort analysis of 33 patients who underwent UCS for PPH during cesarean delivery between January 2011 and July 2025. Patients were categorized based on management with UCS alone or the requirement for additional interventions, including transcatheter arterial embolization (TAE) or emergency peripartum hysterectomy (EPH). RESULTS:UCS alone achieved hemostasis in 23 patients (69.7%), whereas 10 patients (30.3%) required additional treatment (TAE, n = 3; EPH, n = 7). The incidence of suspected placenta accreta spectrum (PAS) was higher among patients requiring additional treatment than among those managed with UCS alone (60.0% vs. 8.7%; p = 0.004). Six of the eight patients with PAS (75.0%) required escalation, whereas all four patients with placental abruption achieved hemostasis with UCS alone; however, this finding should be interpreted cautiously because of the small number of cases. The estimated blood loss and intensive care unit admission rates were higher in the group requiring additional treatment. Ultimately, uterine preservation was achieved in 26 (78.8%) patients. CONCLUSION:In this small retrospective cohort, UCS achieved hemostasis in many patients with PPH during cesarean delivery. Suspected PAS, particularly when complicated by placenta previa or a low-lying placenta, was associated with a higher need for additional treatment after UCS. However, because of the small sample size and limited number of events, these findings should be interpreted as hypothesis-generating rather than as definitive predictors of UCS failure.
BACKGROUND:Reactive hypoglycemia (RH) or low oral glucose tolerance test (OGTT) value has been linked with polyhydramnios and SGA, which is possibly due to placental dysfunction and glucose dysmetabolism. This study aims to investigate the perinatal outcomes associated with placental dysfunction and first-trimester uterine artery resistance in pregnancies with RH or a low 2-hour value on OGTT. METHODS:Pregnant women undergoing OGTT screening after 24 gestational weeks between 2021 and 2023 in maternity units in Indonesia were retrospectively evaluated. Women with multifetal pregnancy, pre-pregnancy diabetes, chronic hypertension, and fetal anomalies were excluded. GDM was diagnosed according to NICE criteria. RH was defined as a 2-hour OGTT value lower than or equivalent to the fasting value. First-trimester uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP) were also recorded. Sensitivity analysis was performed using the other definitions of low OGTT values (2-hour OGTT value < 4 mmol/l and < 5 mmol/l). RESULTS:Of 343 pregnancies, 26 (7.58%) had RH whilst GDM was diagnosed in 70 (20.41%). Compared to women with normal glucose tolerance (NGT), women in the RH group were slimmer, had higher fasting glucose, and higher incidence of abnormal uterine artery resistance (left, right, sum, MoM), low birthweight (15.38% vs 4.05%), neonatal intensive care unit (NICU) admission (11.54% vs 3.24%), and preterm birth (11.54% vs 1.62%). The GDM cohort had higher fasting glucose than either RH or NGT; and a higher incidence of NICU admission (7.14% vs 3.24%) and preterm birth (8.57% vs 1.62%) than NGT, but not as high as women with RH. Abnormal uterine artery resistance and high incidence of adverse outcomes persist in the sensitivity analysis using definitions of 2-hour OGTT value < 4 mmol/l and < 5 mmol/l. CONCLUSIONS:RH may be another clinical presentation of glucose dysmetabolism in pregnancy, prone to adverse pregnancy outcomes, and an even higher frequency of low birthweight babies. The increased first-trimester uterine artery resistance in RH or low OGTT value implies the adverse outcomes may be placenta-driven.
Nasal breathing is an underrecognized and poorly understood component of maternal physiology. Pregnancy remodels nearly every physiologic system, yet whether breathing occurs through the nose or mouth is often overlooked. The nose undergoes hormonally driven adaptations beginning early in gestation. Rising estrogen and progesterone engorge the nasal turbinates, increase mucosal edema, and progressively raise nasal airflow resistance. These changes are frequently dismissed as benign; however, they may carry consequences that extend beyond congestion. This narrative review examines the physiologic functions of the nose in pregnancy, the consequences of impaired nasal airflow, and breathing-based, mechanical, and behavioral strategies intended to preserve nasal function and support maternal health. Nasal breathing conditions inspired air, delivers sinus-derived nitric oxide that supports pulmonary vasodilation and host defense, and participates in the carbon dioxide homeostasis that sustains the maternal-fetal diffusion gradient. Progressive nasal obstruction may contribute to mouth breathing, snoring, sleep fragmentation, and sleep-disordered breathing, conditions associated with hypertensive disorders of pregnancy, gestational diabetes, and other adverse maternal and perinatal outcomes. Nasal breathing practices (pranayama) have been shown to provide therapeutic benefit in the non-pregnant population. Slow nasal breathing, including alternate nostril breathing, has shown favorable effects on respiratory rate, blood pressure, autonomic regulation, sleep, and perceived well-being in preliminary pregnancy studies. Humming-based breathing practices increase nasal nitric oxide and produce acute cardiovascular responses during practice that differ from post-intervention or longer-term effects. Cooling breathing techniques also influence hemodynamic function, whereas energizing practices and breath retention remain insufficiently studied in pregnancy. Mechanical and behavioral approaches, including external nasal dilators, saline irrigation, humidification, and positional strategies, improve nasal patency and symptoms but have not been shown to prevent or treat pregnancy-related sleep-disordered breathing. Mouth taping remains investigational because pregnancy-specific safety and efficacy data are absent. Future studies should objectively characterize nasal function, distinguish among specific breathing techniques, and evaluate maternal symptoms, sleep, autonomic and blood pressure trajectories, fetal growth, and perinatal outcomes. Recognizing the route and pattern of breathing as potentially modifiable dimensions of maternal respiratory physiology may provide new insight into pathways contributing to pregnancy complications and identify opportunities for nonpharmacologic intervention.
BACKGROUND:Globally, preterm birth continues to be a primary contributor to neonatal complications and fatalities. Anemia among the most common nutritional disorders in pregnancy has been proposed as a potential contributor to early delivery. Although extensively studied, the available evidence does not yet provide a clear consensus. This study aimed to conduct a meta-analysis to quantitatively assess the relationship between maternal anemia and the risk of preterm birth. METHODS:This meta-analysis was conducted and reported in accordance with the PRISMA guidelines and the MOOSE checklist. A systematic and exhaustive search was performed across multiple electronic databases PubMed, Scopus, Web of Science, Embase, and the Cochrane Library to identify relevant studies published from inception to 1 January 2025. Effect sizes were combined using a random-effects meta-analysis. RESULTS:A total of 45 articles, reporting 60 independent study populations comprising 2,119,392 pregnant individuals were included. Considerable heterogeneity was found across the included studies (I2 = 95.54%, p < 0.001), which justified the application of a random-effects model for pooling effect sizes. Maternal anemia was significantly associated with an increased risk of preterm birth (pooled odds ratio[OR] = 1.28, 95% confidence interval [CI]: 1.20-1.36, p < 0.001). Despite substantial heterogeneity, sensitivity analyses confirmed the robustness of this association. The relationship was strongest in studies conducted in Asia (OR = 1.30, 95% CI: 1.22-1.40; p < 0.001) and the Europe (OR = 1.24, 95% CI: 1.08-1.41; p = 0.001) and reached statistical significance when anemia was assessed during the first trimester (OR = 1.12, 95% CI: 1.03-1.51; p = 0.007) and the third trimester (OR = 1.65, 95% CI: 1.42-1.91; p < 0.001), while no significant associations were found in the second trimesters (OR = 1.10, 95% CI: 0.99-1.22; p = 0.05). Funnel plot asymmetry and a significant Egger's test (p = 0.001) indicated potential publication bias, although Begg's test was not significant (p = 0.425). CONCLUSIONS:The current evidence suggests that maternal anemia, particularly in the third trimester, is significantly associated with an increased risk of preterm birth. These findings emphasize the clinical imperative for comprehensive and timely anemia screening during the third trimester. Integrating targeted interventions such as iron and micronutrient supplementation, is essential to mitigate the risk of preterm delivery and improve neonatal outcomes.
OBJECTIVE:To investigate the effects of anesthesia type and deferred umbilical cord clamping (DCC) on short-term maternal and neonatal outcomes at Cesarean section (CS). METHODS:This single-center retrospective study of all CS ≥35 weeks from January 2018-December 2023 compared maternal and neonatal outcomes between deliveries with and without DCC ≥60 seconds (s) under general anesthesia (GA) versus regional anesthesia (RA). The cord was clamped earlier for maternal hemorrhage, placental separation, cord avulsion, or infant apnea after 30-60s. Multivariable generalized estimating equations were used to assess the independent and joint effects of anesthesia type and DCC on outcomes, adjusting for emergent CS, chorioamnionitis, and severe preeclampsia/eclampsia. RESULTS:4341 mothers and 4463 infants were studied. DCC was performed in 62% (121/195) of GA and 87% (3728/4268) of RA infants. Interaction analyses demonstrated that the association between DCC and postpartum hemorrhage (PPH) differed by anesthesia type. Among mothers receiving GA, DCC ≥60s was not associated with PPH ≥1000 mL (50% vs 42%, p=.3) or transfusion (15% vs 16%, p=.8), whereas among RA mothers, DCC ≥60s was associated with lower adjusted probabilities of PPH (25% vs 48%, p<.001) and transfusion (5% vs 15%, p<.001). There was no significant interaction between DCC ≥60s and anesthesia type for neonatal outcomes. DCC ≥60s was associated with lower adjusted odds of 5-min APGAR <7 (OR 0.2 (0.2-0.4), p<.001), delivery room (DR) intubation (OR 0.0 (0.0-0.2), p<.001), umbilical artery pH < 7 (OR 0.5 (0.3-0.8), p=.007) and NICU admission (OR 0.5 (0.4-0.6), p<.001). CONCLUSION:Regardless of anesthesia type, DCC ≥60s was not associated with higher risks of PPH or transfusion among mothers; and was not associated with any detriment in short term neonatal outcomes. We suggest that GA deliveries can be safely considered eligible for DCC under a standardized institutional protocol with predefined exit criteria.
OBJECTIVES:Maternal obesity is a well-known factor influencing pregnancy outcomes. However, the influence of maternal obesity on neonatal neurological morbidities, such as intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and retinopathy of prematurity (ROP), remains unclear. We aimed to evaluate the association between maternal body mass index (BMI) and short-term neonatal neurological morbidities using a nationwide cohort. METHODS:Using the Korean National Health Information Database, we conducted a retrospective cohort study with data obtained between 2014 and 2021. Maternal BMI was categorized on the basis of the Asia-Pacific classification: underweight (< 18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), obese class I (25.0-29.9 kg/m2), and obese class II or higher (≥ 30.0 kg/m2). Neonatal outcomes (IVH, PVL, and ROP) were identified using ICD-10 codes. Inverse probability of treatment weighting was used to adjust for potential confounders. The relative risks (RRs) for each outcome were estimated using robust Poisson regression. RESULTS:Among 779,091 neonates, a dose-dependent increase in risk was observed across higher BMI categories. Maternal obesity (BMI ≥ 30.0 kg/m2) was associated with significantly higher risks of IVH (RR, 3.19; 95% confidence interval [CI], 3.02-3.36), PVL (RR, 3.02; 95% CI, 2.75-3.32), and ROP (RR, 3.66; 95% CI, 3.37-3.98) in comparison with normal BMI. Conversely, maternal underweight (BMI < 18.5 kg/m2) was associated with reduced risk of IVH (RR, 0.86; 95% CI, 0.81-0.92), PVL (RR, 0.86; 95% CI, 0.76-0.96), and ROP (RR, 0.73; 95% CI, 0.65-0.82). CONCLUSIONS:Maternal obesity was associated with an increased risk of neonatal neurological morbidities, including IVH, PVL, and ROP, with a dose-dependent association. These findings emphasize the importance of optimizing maternal BMI before pregnancy to reduce the risk of neurological complications in neonates and demonstrate the need for public health policies focused on maternal weight management.
OBJECTIVE:This study aimed to investigate the correlations of late-pregnancy homocysteine (Hcy) and lipid profiles with disease severity in hypertensive disorders of pregnancy (HDP) and evaluate their predictive value for subsequent neonatal outcomes. METHODS:In total, 156 patients with HDP (61 with gestational hypertension [GH] and 95 with preeclampsia [PE]) were retrospectively analyzed. Clinical characteristics and laboratory parameters, including Hcy and blood lipid profiles, were collected. Logistic regression and subgroup analyses were used to identify the factors related to adverse neonatal outcomes, and receiver operating characteristic (ROC) curves were applied to assess their predictive performance. RESULTS:Significant differences in systolic blood pressure, Hcy, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol (TC), triglyceride (TG), and albumin levels were observed between the GH and PE groups. Based on subgroup analyses and logistic regression data, increased Hcy, TC, and TG levels were independently associated with PE status. Additionally, higher late-pregnancy Hcy and TG levels and lower late-pregnancy HDL-C levels were significantly associated with an increased risk of adverse neonatal outcomes. The combined detection of Hcy, TG, and HDL-C demonstrated better predictive performance (the area under the ROC curve = 0.874, 95% CI: 0.812-0.922) than every single detection. CONCLUSION:Elevated Hcy and TG levels and reduced HDL-C levels in the late pregnancy are significantly associated with disease severity and adverse neonatal outcomes in HDP. Combined assessment of these biomarkers may serve as a useful adjunct for predicting adverse neonatal outcomes.
BACKGROUND:Operative vaginal delivery (OVD) is an important alternative to cesarean section, but the relative outcomes of vacuum, forceps, and sequential vacuum + forceps approaches remain uncertain. Moreover, predictors of instrument choice are incompletely understood. This study aimed to compare maternal, intrapartum, and neonatal outcomes across OVD modalities and to integrate conventional statistics with machine learning to identify key predictive factors. METHODS:We retrospectively analyzed 967 singleton deliveries at a tertiary center: vacuum (n = 208), forceps (n = 706), and sequential vacuum + forceps (n = 53). Maternal characteristics, intrapartum variables, and neonatal outcomes were compared using ANOVA and chi-square tests. A Random Forest classifier was trained to rank predictors of delivery mode, with performance assessed by accuracy, AUC, and Cohen's κ. RESULTS:Forceps deliveries were more frequent among younger, primiparous women, while vacuum was used in older, higher-parity mothers with better base excess (BE). Vacuum + forceps deliveries had the longest decision-to-delivery interval (26.9 vs. 17.7 and 16.8 min, p < 0.001), highest rates of severe perineal laceration (73.6% vs. 34.1% and 47.5%, p < 0.001), and poorest neonatal outcomes, including lower Apgar scores and higher cephalohematoma, hyperbilirubinemia, and transfer rates. Random Forest achieved 73.7% accuracy (AUC 0.758) and identified second-stage duration, decision-to-delivery time, lactate, and BE as top predictors, some not significant in univariate tests. CONCLUSIONS:Vacuum and forceps each have distinct maternal and neonatal risk profiles, while sequential vacuum + forceps delivery confers the greatest morbidity, largely reflecting case complexity. Traditional statistics and machine learning offer complementary insights, highlighting both established and novel predictors. Integrating these approaches may support individualized decision-making and improve OVD outcomes.
BACKGROUND:Fetal growth restriction (FGR) is associated with progressive hemodynamic deterioration and subclinical cardiac dysfunction. The modified Bernoulli equation applied to ductus venosus and pulmonary vein Doppler velocities allows noninvasive estimation of fetal interatrial pressure gradients; however, the utility of this approach in FGR has not been empirically evaluated. METHODS:This prospective case-control study, conducted at a single tertiary referral center, enrolled 40 late-onset FGR fetuses meeting Delphi consensus criteria and 40 gestational age-matched controls. Doppler-derived estimated interatrial pressure-gradient indices were calculated noninvasively by applying the modified Bernoulli equation to ductus venosus and pulmonary vein Doppler peak velocities obtained sequentially during the same examination session. In addition, standard arterial and venous fetal Doppler indices were recorded. Group comparisons were performed using the Mann-Whitney U test, with effect sizes quantified by Cliff's delta. RESULTS:No significant difference was observed in any of the three estimated interatrial pressure gradient indices between FGR and control fetuses (p = 0.447, p = 0.665, and p = 0.729, respectively). Pulmonary vein D-wave velocity was significantly reduced in FGR fetuses (18.20 [IQR 13.43-22.40] vs. 20.90 [IQR 15.97-25.60] cm/s; p = 0.021), whereas ductus venosus velocity parameters did not differ between groups. In a subgroup analysis of eight FGR fetuses with umbilical artery pulsatility index at or above the 95th centile, all three gradient indices were significantly lower than in controls (p ≤ 0.010), with large effect sizes (Cliff's δ 0.581 to 0.762). CONCLUSIONS:Doppler-derived estimated interatrial pressure-gradient indices do not differ significantly between FGR and control fetuses in the absence of ductus venosus a-wave abnormalities. In an exploratory subgroup analysis, significantly lower gradient indices were observed in fetuses with UA PI at or above the 95th centile; this finding should be considered hypothesis-generating. Furthermore, pulmonary vein D-wave velocity was significantly reduced in FGR fetuses, a finding that may reflect altered left ventricular diastolic filling dynamics; however, definitive conclusions regarding diastolic dysfunction require dedicated cardiac function assessment. Collectively, these findings provide the first characterization of Doppler-derived estimated interatrial pressure-gradient indices in late-onset FGR and suggest that interatrial hemodynamic alterations emerge only at more advanced stages of fetoplacental compromise.
INTRODUCTION:Hemolytic disease of the fetus and newborn (HDFN) and fetal and neonatal alloimmune thrombocytopenia (FNAIT) are two rare alloimmune diseases of pregnancies where maternal alloantibodies target fetal blood components, potentially leading to risks of serious health conditions and developmental delays for babies, and sometimes loss of the baby. HDFN and FNAIT often have similarly complex journeys, from diagnosis through to burdensome treatments such as intrauterine transfusions and intravenous immunoglobulin. OUR STORIES:We, the authors, are two mothers with lived experience of these conditions; here, we present our perspectives and insights to raise awareness and to share encouragement with other mothers. Although our experiences of diagnoses and treatments differed, our shared perspectives of HDFN, FNAIT, and alloimmunization collectively highlight the importance of early recognition, multidisciplinary coordination, compassionate communication, and increased provider education about these rare conditions. While we were both fortunate to have access to diagnostics, monitoring, and specialized therapies, we know that many mothers do not have access to such resources. Our shared experiences also highlight the emotional and mental health impacts of pregnancies with prolonged high risk, maternal-infant separation, and intensive treatments requiring us to leave our families at home while we attended appointments and hospital stays. This extended treatment burden also affects ability to work and impacts healthcare costs, and there is a critical need to integrate psychosocial support alongside medical management to meaningfully improve the patient experience. DISCUSSION AND REFLECTIONS:Despite these stresses, medical progress continues to be made, and we can say from experience that there was opportunity for hope and joy along the way in our pregnancies and in the births of our sons, who are now happy and thriving.
Fetal growth restriction (FGR) affects 5%-10% of pregnancies and remains a major contributor to stillbirth, neonatal morbidity, and long-term adverse outcomes. Despite its clinical importance, substantial controversy persists regarding its definition, diagnostic criteria, surveillance modalities, and optimal timing of delivery. Divergence among major professional societies reflects gaps in outcome-based evidence and differing philosophical approaches to physiologic staging. This review examines current controversies and proposes a pragmatic approach to harmonize practice. We propose incorporating fetal growth velocity (>2 quartile drop) into the diagnostic criteria for FGR in conjunction with estimated fetal weight and abdominal circumference. In addition, we recommend assessment of the ductus venosus in pregnancies complicated by early-onset FGR and abnormal umbilical artery Doppler findings. We also support offering amniocentesis for genetic testing in all cases of unexplained FGR and propose delivery thresholds based on both biometric parameters and Doppler abnormalities to better guide clinical management.
INTRODUCTION:Chronic histiocytic intervillositis (CHI) is a rare placental lesion associated with an aberrant, noninfectious activation of the maternal immune response. Macrophages then accumulate within the intervillous space of the placenta, with associated adverse outcomes. This study aimed to describe clinical characteristics and treatment outcomes in subsequent pregnancies of patients diagnosed with CHI. METHODS:This retrospective exploratory analysis utilized data abstracted from electronic medical records at a single institution. Patients with at least one pregnancy diagnosed with CHI confirmed by placental histopathology reports were included. Patients with intervillositis of infectious origin were excluded. RESULTS:Nineteen patients were included, with the majority being white (89.5%, n = 17), with a median age of 27 years at the time of delivery. Ten (52.6%) patients had autoimmune disease, and 11 (57.9%) had hypertension. Among the 19 patients, there were 61 pregnancies. Nineteen (31.1%) were pregnancies in which CHI was initially diagnosed (index pregnancy), and 47.5% (29/61) of pregnancies occurred after the index pregnancy. Of these post-index pregnancies, 70% (7/10) were diagnosed with CHI based on available placental pathology. Twenty (38.2%) pregnancies reported complications. Pregnancy loss occurred in 55% (11/20) of index pregnancies, and 40% (10/25) of post-index pregnancies. Nineteen (70%) post-index pregnancies received immunomodulatory treatment. Of pregnancies where treatment was not initiated, 61.1% (22/36) resulted in loss, while in pregnancies that received treatment, 21.1% (4/19) resulted in loss (p = 0.004). DISCUSSION:Patients who initiated immunomodulatory treatment in post-index pregnancies had an associated decrease in placental fibrin deposition and were associated with a higher rate of living children.
OBJECTIVE:To investigate whether platelet indices mediate the association between pre-pregnancy body mass index (pBMI) and late-onset preeclampsia (LOPE). METHODS:This study retrospectively collected cohort data from 1,198 pregnant women between July 2021 and June 2023. The relationships among pBMI, platelet indices, and LOPE were assessed using logistic regression and Pearson correlation analyses. Mediation analysis was employed to evaluate the mediating effects of PC and PCT on the association between pBMI and LOPE. RESULTS:Compared to the control group, pregnant women with a pBMI ≥ 25 kg/m2 had a 3.342-fold increased risk of subsequently developing LOPE. A significant positive correlation was observed between pre-pregnancy BMI and both PC and PCT at 16-19 weeks of gestation (p < 0.001), and elevated levels of PC and PCT were significantly associated with an increased risk of LOPE (p < 0.05). Mediation analysis demonstrated that PC and PCT partially mediated the association between pBMI and LOPE, accounting for 8.61% and 11.99% of the total effect, respectively. CONCLUSION:A higher pre-pregnancy BMI is associated with elevated platelet indices in early pregnancy, and these elevated indices may partially mediate the association between pre-pregnancy overweight/obesity and LOPE.
BACKGROUND:Obstetric hemorrhage is a leading preventable cause of maternal mortality (MM) worldwide. This study described MM due to obstetric hemorrhage in Brazil and examined temporal trends and associations with maternal age, skin color, educational level, and geographic region. METHOD:We conducted a nationwide population-based cross-sectional study using data from the Mortality Information System (SIM) and Live Birth Information System (SINASC), including 2,985 hemorrhage-related maternal deaths recorded between 2015 and 2024. Causes were classified as first-half pregnancy hemorrhage, placental/intrapartum hemorrhage, or postpartum hemorrhage. RESULTS:Overall, hemorrhage accounted for 17.2% of maternal deaths (MMRH 10.86 per 100,000 live births), with no significant temporal change during the study period. Postpartum hemorrhage accounted for 38.96% of deaths, followed by placental/intrapartum hemorrhage (33.74%) and first-half pregnancy hemorrhage (27.30%). Overall, hemorrhage accounted for 17.2% of maternal deaths (MMRH 10.86 per 100,000 live births), with no significant temporal change during the study period. Marked disparities were observed across population groups. Indigenous and Black women had 2.87-fold (95% CI 2.23-3.70) and 1.66-fold (95% CI 1.44-1.92) higher prevalence of hemorrhagic maternal death than White women, respectively. Women aged ≥40 years had nearly fourfold higher risk than those aged 20-29 years (PR 3.90; 95% CI 3.38-4.51), while women with no formal education had almost tenfold higher risk than those with ≥12 years of education (PR 9.68; 95% CI 7.46-12.56). The North region showed the highest excess risk (PR 1.84; 95% CI 1.56-2.15). CONCLUSION:Reducing hemorrhagic maternal mortality in Brazil requires strengthening evidence-based hemorrhage care while addressing persistent racial, educational, and regional inequalities.
Objective Early-onset Group B Streptococcus (EOGBS) infection in neonates is prevented with intrapartum antibiotic prophylaxis (IAP). Traditionally, IAP candidates are identified via antepartum microbiological culture or clinical risk factors. While these strategies have reduced EOGBS incidence in many countries, some cases potentially preventable with IAP are missed. Point-of-care polymerase chain reaction (PCR) tests offer a promising alternative to detect intrapartum GBS colonization in near-patient settings and inform IAP use, addressing limitations of traditional approaches. Despite existing European clinical consensus recommending PCR-based intrapartum screening, its adoption is limited, partially due to lack of health economic data. The objective of this study was to assess the clinical and economic impact of EOGBS prevention strategies from a French healthcare system perspective.Methods We developed a decision-analytic model and an abbreviated budget impact model to simulate different EOGBS prevention strategies (antepartum and intrapartum screening, risk-factor-based IAP) among pregnant women with any combination of risk factors and their impact on EOGBS incidence. The model incorporated short-term costs related to GBS screening, IAP, EOGBS treatment, and lifetime costs and outcomes associated with long-term complications among infants who survive EOGBS (e.g. quality-adjusted life years [QALY]). For the reference case, we compared a strategy of intrapartum PCR screening of pregnant women without risk factors against universal antepartum culture screening.Results The model estimated that the intrapartum PCR screening strategy provided QALY gains at lower costs compared to the antepartum culture-based screening strategy, reducing EOGBS incidence by 14.14%, with 21,910 pregnant women tested intrapartum to prevent one EOGBS case. Applied to annual deliveries in France (2022), intrapartum PCR testing was projected to prevent 32 EOGBS cases and ∼2 EOGBS-related deaths per year compared to the antepartum culture-based screening strategy. The budget impact analysis indicated lower screening and EOGBS management costs with intrapartum PCR testing, with estimated annual savings of €895,711 for the French healthcare system.Conclusion An EOGBS prevention strategy incorporating intrapartum PCR screening may reduce EOGBS incidence and healthcare costs for the French healthcare system compared to current antepartum culture-based screening practices.
OBJECTIVE:This study aimed to investigate the diagnostic utility of serial peripheral blood eosinophil percentage (PBEP) monitoring in differentiating cow's milk protein allergy (CMPA) from necrotizing enterocolitis (NEC) in neonates, and to quantify the diagnostic delay associated with a preceding NEC diagnosis in neonates subsequently diagnosed with CMPA. METHODS:This retrospective cohort study was conducted at a tertiary neonatal intensive care unit (NICU) between 2015 and 2025. A total of 112 neonates were enrolled and divided into three groups: Group 1 (NEC + CMPA, n = 39), Group 2 (CMPA only, n = 33), and Group 3 (NEC only, n = 40). PBEP was assessed at two time points, initial admission and at the time of confirmed diagnosis, for all groups. The magnitude of eosinophil change (ΔPBEP) was calculated for each patient. Receiver operating characteristic (ROC) curve analysis with Youden Index-based cutoff determination was performed to evaluate the discriminative performance of PBEP. Multinomial logistic regression analysis was applied to identify independent determinants of group membership. RESULTS:Initial PBEP was comparable across all three groups (p = 0.685). At follow-up, PBEP increased markedly in Group 1 (15.57 ± 6.84%) and Group 2 (12.43 ± 6.93%), while remaining low in Group 3 (2.98 ± 1.62%) (p < 0.001). ΔPBEP was significantly greater in Group 1 and Group 2 compared with Group 3 (p < 0.001). ROC analysis demonstrated poor discriminative performance for initial PBEP (AUC = 0.463), whereas follow-up PBEP showed excellent diagnostic accuracy (AUC = 0.986; optimal cutoff: ≥5.20%; sensitivity: 97.2%; specificity: 92.5%; PPV: 95.9%; NPV: 94.9%). Diagnostic delay was significantly longer in Group 1 (15.2 ± 13.6 days) compared with Group 2 (7.0 ± 9.9 days) (p < 0.001). Multinomial logistic regression identified the absence of sepsis as the only independent determinant of membership in Group 2 (OR = 4.319; 95% CI: 1.217-15.323; p = 0.024), and ΔPBEP as the only independent determinant distinguishing Group 3 from Group 1 (OR = 0.047; 95% CI: 0.002-0.945; p = 0.046). CONCLUSION:Serial PBEP monitoring may serve as a practical, noninvasive, and readily available biomarker for differentiating CMPA from NEC in the NICU. While initial PBEP lacks discriminative value, follow-up PBEP demonstrates excellent diagnostic accuracy. A preceding NEC diagnosis may be associated with a substantial diagnostic delay, highlighting the importance of considering CMPA in neonates with recurrent suspected NEC episodes, particularly when gastrointestinal symptoms persist or recur despite standard NEC treatment.
OBJECTIVE:The primary objective was to compare endostatin levels between patients with preeclampsia and those with normal pregnancies. The secondary objectives comprised comparing endostatin levels in early-onset preeclampsia, late-onset preeclampsia, and normal pregnancies, as well as comparing pregnancy and neonatal outcomes between preeclampsia and normal pregnancies. METHODS:This cross-sectional analytic study included 68 patients with preeclampsia and 68 normal pregnancies. The groups were matched for gestational age. The study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, from July 2024 to July 2025. Blood samples were collected in non-heparinized tubes and stored at -80 °C until assayed. Maternal endostatin levels were measured using enzyme-linked immunosorbent assays (ELISA). Maternal and neonatal outcomes were recorded. RESULTS:The median serum endostatin level in patients with preeclampsia was not significantly different from that in normal pregnancies (3.45 vs. 4.32 ng/ml, p = 0.304). The median endostatin levels in early-onset preeclampsia and late-onset preeclampsia did not differ from those in normal pregnancies at the same gestational age (2.84 vs. 7.09 ng/ml, p = 0.05, and 3.86 vs. 4.26 ng/ml, p = 0.845, respectively). Patients with preeclampsia had a higher rate of cesarean delivery (63.2% vs. 41.2%, p = 0.01) and a higher rate of composite maternal complications (16.2% vs. 1.5%, p = 0.004) compared to normal pregnancies. Preeclampsia patients had lower neonatal birth weight (2,419 ± 655 vs. 2,903 ± 507 g, p < 0.001) and longer neonatal lengths of stay (median 5 vs. 4 days, p = 0.01) than those in normal pregnancy. CONCLUSIONS:The endostatin level in patients with preeclampsia was not statistically different from that in normal pregnancies. These research findings refute the hypothesis that serum endostatin levels are higher in preeclampsia. Therefore, serum endostatin levels may not be a reliable biomarker for predicting preeclampsia in this population. Preeclampsia is associated with adverse maternal and neonatal outcomes.
BACKGROUND:Despite strong evidence supporting exclusive breastfeeding (EBF) for the first six months of life, global and national rates remain suboptimal. In the critical first 48-72 hours after birth, several widespread clinical practices and beliefs, unsupported by current evidence, may inadvertently undermine breastfeeding initiation and continuation in healthy term neonates. OBJECTIVE:To critically examine the available evidence on three clinical practices that may compromise early breastfeeding establishment in healthy term neonates: the perception that colostrum volumes are insufficient for the newborn's needs, the routine restriction of pacifier use, and the early introduction of electric breast pumps as a substitute for direct breastfeeding or hand expression. METHODS:Narrative review of evidence from randomised controlled trials, systematic reviews, meta-analyses, and observational cohort studies, addressing three evidence-practice gaps relevant to the first 48-72 hours postpartum: (1) the physiology of colostrum production and the mismatch between normal volumes and maternal/professional expectations; (2) the effect of pacifier use on breastfeeding outcomes in term infants; and (3) the impact of breast pump use in the first days of life on breastfeeding duration and exclusivity. RESULTS:Colostrum volumes (2-10 mL per feed, 30-60 mL/day in the first 72 hours) are physiologically matched to neonatal gastric capacity and metabolic needs; perceived insufficient milk supply is overwhelmingly driven by unrealistic expectations rather than true lactation failure. Randomised evidence shows that small-volume, structured formula supplementation does not compromise breastfeeding duration, and that pacifier use in healthy breastfeeding term infants does not reduce breastfeeding rates. Routine introduction of electric breast pumps in the first days of life is associated with shorter breastfeeding duration; hand expression yields greater colostrum volumes and is associated with higher breastfeeding rates at two months than electric pumping. CONCLUSIONS:Evidence-based counselling on colostrum sufficiency, individualised pacifier counselling, and prioritisation of hand expression over routine electric pump use in the first 48-72 hours could meaningfully improve breastfeeding outcomes in healthy term neonates. Future research should prioritise pragmatic cluster-randomised trials evaluating bundled interventions in routine maternity care settings.
OBJECTIVE:Early onset fetal growth restriction (FGR) shares pathophysiologic origins and may precede the development of Hypertensive Disorder of Pregnancy (HDP). The aim of this study was to evaluate risk factors associated with the development of HDP in individuals with early onset FGR. METHODS:This retrospective cohort included all consecutive patients who presented to our tertiary, university-affiliated medical center between 2011 and 2024 for suspected early-onset FGR, defined as onset before 32 weeks of gestation. Maternal and pregnancy information retrieved from hospital records included maternal age, BMI, smoking history, parity, gestational age (GA) at diagnosis, chronic hypertension, maternal cardiac disease, pre- or gestational diabetes, thrombophilia, chronic renal disease, history of major pregnancy complications, mode of conception, number of fetuses, premature contractions (PMC), ultrasound (US) measured abdominal circumference (AC), US measured estimated fetal weight (EFW), umbilical artery Doppler PI (UAPI) and middle cerebral artery Doppler PI (MCAPI). AC and EFW were classified as <5% and <3% respectively based on local population growth charts. UAPI and MCAPI percentiles were calculated per specific GA. We present maternal and pregnancy characteristics stratified by the development of HDP and investigated the association of these variables with development of HDP using univariate and multivariable logistic regression. The analyses were performed using R statistical software, and statistical significance was defined as p < 0.05. RESULTS:During the study period 774 pregnant individuals were presented for suspected early-onset FGR. Among them, 79 (10.2%) subsequently developed HDP later in pregnancy. Using multivariate analysis UAPI above the 95th percentile (OR 3.35, CI 1.55-7.20, p < 0.01), GA 24-28 weeks at diagnosis (OR 2.54, CI 1.20-5.36, p = 0.01) and AC below the 5th percentile (OR 2.31, CI 1.10-4.86, p = 0.02), were significantly associated with the subsequent development of HDP. CONCLUSION:Among pregnancies with suspected early-onset FGR, an elevated UAPI (>95th percentile) was the strongest predictor of developing HDP. Additional risk factors included earlier gestational age at FGR diagnosis and an AC below the 5th percentile. Women with these risk factors warrant intensified maternal surveillance. Future studies integrating these clinical predictors with circulating angiogenic biomarkers may further refine risk stratification.
