Gestational diabetes mellitus (GDM) is a heterogeneous condition arising from the complex interplay between maternal metabolic characteristics and placental adaptations. Traditionally, GMD has been classified by the timing of onset; however, this approach fails to capture the underlying pathophysiological diversity. Accordingly, increasing evidence suggests that hyperglycemia in pregnancy may arise either from preexisting maternal metabolic vulnerability—characterized by insulin resistance, obesity, and cardiometabolic risk factors—or from pregnancy-specific placental influences that alter maternal glucose homeostasis. We provide an overview of these two trajectories, which we term maternal-origin and placental-origin GDM, illustrating how these two distinct pathways converge to result in GDM, while exhibiting differences in underlying biology, etiological mechanisms, and potential clinical implications. Maternal-origin GDM is typically associated with more pronounced hyperglycemia, earlier detection, and a higher risk of chronic metabolic complications, underscoring the need for close monitoring and management both during and after pregnancy. In contrast, placental-origin GDM tends to manifest later in gestation, involves milder dysglycemia, and reflects both physiological and maladaptive endocrine activity of the placenta acting upon an otherwise metabolically healthy mother. The interaction between maternal and placental factors can generate a self-reinforcing cycle of inflammation, oxidative stress, and insulin resistance and may also underline mixed phenotypes. Recognizing distinct etiological origins of GDM not only provides a pathophysiological framework for interpreting the diverse clinical presentations but also can suggest tailored strategies for clinical approach. Shifting beyond a purely time-based classification emphasizes the importance of identifying the underlying drivers of dysglycemia, thereby enabling the potential for individualized care.

GDM is one of the most common complications of pregnancy affecting around 14

BACKGROUND:Cardiovascular disease (CVD) is the leading indirect cause of maternal morbidity and mortality in high-income countries. Managing pregnant women with cardiac conditions requires multidisciplinary coordination and individualized planning. Early risk stratification, commonly performed using the modified World Health Organization (mWHO) classification, is essential to guide the management of pregnant women with heart disease. The Delivery Plan (DP) is proposed as a standardized tool to guide peripartum care in this population. OBJECTIVE:To evaluate expert consensus on the structure and implementation of a standardized DP for pregnant women with heart disease, using a modified Delphi methodology. METHODS:A two-round Delphi survey was conducted among 30 cardio-obstetric experts from five tertiary Italian centers. The first phase assessed current practices regarding cardiac follow-up and investigations in pregnancy. The second phase evaluated agreement on 21 proposed DP items across different mWHO risk classes and explored the role of non-cardiac risk factors. RESULTS:In phase one, consensus (≥70% agreement) was achieved for 78.4% of cardiac follow-up practices and 87.9% of diagnostic investigations. In phase two, all 21 DP items were endorsed for general inclusion. Stratification by mWHO risk class showed no consensus for mWHO I, partial agreement for mWHO II, and full consensus for mWHO II/III to IV. Strong agreement (median ≥ 9, IQR ≤ 2) was observed for most items in higher-risk classes. Additionally, obesity, hypertension, and preeclampsia were identified as relevant non-cardiac risk factors warranting structured planning. CONCLUSIONS:The study supports the use of a structured, risk-adapted DP for pregnant women with cardiac disease. High consensus in moderate-to-severe risk groups confirms the DP's utility in enhancing multidisciplinary coordination and may contribute to improved maternal-fetal outcomes, pending prospective validation.

OBJECTIVE:To develop standardised Objective Structured Assessment of Technical Skills (OSATS) forms for major obstetric emergencies, thereby improving the quality and consistency of obstetric simulation training. DESIGN AND SETTING:A panel of national experts with extensive experience in teaching Gynaecology and Obstetrics, simulation training, and the clinical management of labour complications and peripartum emergencies. POPULATION AND METHODS:A Delphi process with four iterative rounds was conducted to create, evaluate, revise, and finalise OSATS checklists for 11 obstetric emergencies. Each OSATS form was rated using a Likert scale (0-9), refined according to expert feedback, and validated through structured discussions. MAIN OUTCOME MEASURES:The creation and approval of OSATS forms for shoulder dystocia, vacuum delivery, assisted breech delivery, third- and fourth-degree laceration repair, external cephalic version, abnormal CTG management, postpartum haemorrhage, non-cephalic second twin delivery, reverse breech extraction at caesarean section, maternal collapse and forceps application. RESULTS:Consensus was achieved for all emergencies with good to excellent ratings: shoulder dystocia (82%), external cephalic version (94%), vacuum delivery (75%), abnormal CTG management (42%), postpartum haemorrhage (96%), reverse breech extraction (72%), maternal collapse (94%), forceps application (76%), non-cephalic second twin delivery (96%), assisted breech delivery (94%) and third- and fourth-degree laceration repair (82%). CONCLUSION:The Delphi study successfully developed consensus-based OSATS forms, addressing the need for standardised assessments in obstetric simulation training. These tools enhance training quality, identify skill gaps and improve clinical preparedness. This study was supported by AGUI (Associazione Ginecologi Universitari Italiani).

Objectives: To assess the impact of intravenous ferric carboxymaltose (FCM) on fetal and maternal adverse effects in pregnant women diagnosed with iron deficiency anemia (IDA). Methods: This is a multicenter retrospective study on 472 pregnant women diagnosed with moderate to severe IDA undergoing treatment with FCM between 2019 and 2025 at Careggi University Hospital (Florence) and Vittore Buzzi Children Hospital (Milan). Fetal wellbeing was assessed using computerized cardiotocography (cCTG) or ultrasound, based on gestational age at treatment. Maternal side effects were evaluated through clinical evaluation. Results: cCTG was performed in 377/472 patients (80%), with a mean short-term variability of 10.2 ms. Normal cCTG criteria were met in 98.4% of cases; six patients exhibited transient reduced variability, which resolved following intrauterine resuscitation. Ultrasound assessment was performed in 95 patients (20%), revealing no fetal heart rate abnormalities. Maternal side effects occurred in seven patients (1.4%). Hemoglobin concentrations increased by a median of 1.4 g/dL after five weeks, reaching up to 2.8 g/dL in women with a baseline Hb < 8 g/dL. Conclusions: Our findings support the potential safety and efficacy of intravenous FCM for the treatment of IDA during pregnancy, demonstrating low rates of maternal side effects and no adverse fetal heart rate patterns. However, prospective studies are necessary to confirm these results.

The preconceptional period is crucial for women and couples who desire children as it influences the progress and outcomes of a healthy pregnancy. Preconceptional care is now an accepted paradigm by most healthcare professionals. However, its implementation in healthcare programs is still in the early stages. Preconceptional care starts with communication and a collection of personal and family medical history. It then encompasses a variety of recommendations for lifestyle interventions, as well as preventive laboratory tests. This review will summarize current recommended procedures, from nutritional to disease screening, and their impact on pregnancy outcomes. Folic acid supplementation has been shown to significantly decrease complications such as neural tube defects, and is now widely recommended during the preconceptional phase. Additionally, nutritional supplementation, including the intake of vitamins D and B12, has been linked to healthier pregnancies. Screening for ToRCH infections (toxoplasmosis, syphilis, hepatitis B, rubella, cytomegalovirus, and herpes simplex virus), as well as non-infectious conditions, may help avoid complications during pregnancy. This review will also provide an overview of current practices worldwide, focusing on the Italian context. This document will be helpful to update the medical community, especially gynecologists, on the current knowledge of the benefits of 1) maintaining a healthy nutritional state, including vitamin and mineral supplementation, 2) screening strategies for infectious and non-infectious diseases, and 3) avoiding dangerous behaviors, such as smoking, alcohol consumption, and drug use, for women and couples planning a pregnancy. It also provides suggestions on how to identify such couples to best intervene during the "window of opportunity". Finally, we aim to provide a simple decalogue, which healthcare professionals can use as a checklist. It can also be delivered directly to women or couples planning a pregnancy, reaching them with straightforward language.

( Am J Obstet Gynecol . 2025;232:328.e1-9. DOI: 10.1016/j.ajog.2024.06.011) Fetal death, affecting over 2 million cases globally each year, remains poorly understood despite its prevalence. About 60% of fetal deaths after 28 weeks of gestation are unexplained and without known risk factors. Evidence increasingly suggests that the placenta plays a vital role in this condition, specifically placental vascular malperfusion, placental senescence, and hypoxic-ischemic stress. The placenta is responsible for producing hormones, cytokines, and growth factors that regulate the relationship between the mother and fetus. Disruptions in the release of these substances have been linked to fetal death. Expression and function of these substances may be altered by clinical scenarios such as inflammation and infection.

This study aimed to evaluate the outcomes of pregnancies immediately following stillbirth in relation to treatments prescribed.A prospective, observational study was conducted in patients with a history of stillbirth (≥22 weeks) between 2014 and 2022 across four Italian University Hospitals. Outcomes were stratified based on the cause of previous fetal death (classified according to ReCoDe classification) and treatment (low dose aspirin [LDA], low molecular weight heparin [LMWH], both, progesterone, or other drugs). The main outcome was adverse neonatal outcome, including perinatal death, stillbirth recurrence, intrauterine growth restriction, early preterm birth, Apgar < 7 at 5 minutes, and need for neonatal resuscitation. The secondary outcome was adverse maternal outcome, including postpartum hemorrhage, emergency cesarean delivery, and operative vaginal delivery.Among 308 subsequent pregnancies, 46 (14.94%) had an adverse neonatal outcome, including 4 stillbirths. A total of 76 pregnancies (24.68%) experienced adverse maternal outcome, and 19 pregnancies (6.17%) had both. In individuals with previous placental vascular disorders (PVDs), adverse neonatal outcomes were reduced by 75% when treated with LDA + LMWH (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.06-1.03; p = 0.049). However, adverse maternal outcome was significantly higher in individuals who received LDA + LMWH without specific indications (OR: 3.07; 95% CI: 1.07-8.78; p = 0.036).LDA and LMWH should be prescribed only for previous PVDs to improve adverse neonatal outcome and avoid unnecessary maternal risk. · LDA + LMWH reduces neonatal risk after placental stillbirths.. · Unnecessary LDA + LMWH increases maternal complications.. · Prescribe LDA + LMWH only with placental indications..

We report the case of a young woman with Fontan circulation who successfully completed a twin pregnancy. The key role of a multidisciplinary Pregnancy Heart Team for preconception counseling and pregnancy management is emphasized.

Background: It is estimated that over 2 million cases of fetal death occur worldwide every year, but, despite the high incidence, several basic and clinical characteristics of this disorder are still unclear. Placenta is suggested to play a central role in fetal death. Placenta produces hormones, cytokines and growth factors that modulate functions of the placental-maternal unit. Fetal death has been correlated with impaired secretion of some of these regulatory factors. Objective: The aim of the present study was to evaluate, in placentas collected from fetal death, the gene expression of inflammatory, proliferative and protective factors. Study Design: Cases of fetal death in singleton pregnancy were retrospectively selected, excluding pregnancies complicated by fetal anomalies, gestational diabetes, intrauterine growth restriction and moderate to severe maternal diseases. A group of placentas collected from healthy singleton term pregnancies were used as controls. Groups were compared regarding maternal and gestational age, fetal sex and birthweight. Placental messenger RNA expression of inflammatory (interleukin 6), proliferative (activin A, transforming growth factor beta 1) and regulatory (vascular endothelial growth factor, vascular endothelial growth factor receptor 2, ATP-binding cassette transporters (ABC) ABCB1 and ABCG2, sphingosine 1-phosphate signaling pathway) markers was conducted using real-time polymerase chain reaction. Statistical analysis and graphical representation of the data were performed using the GraphPad Prism 5 software. For the statistical analysis, Student's t test was used, and P values<.05 were considered significant. Results: Placental mRNA expression of interleukin 6 and vascular endothelial growth factor receptor 2 resulted significantly higher in the fetal death group compared to controls (P<.01), while activin A, ABCB1, and ABCG2 expression resulted significantly lower (P<.01). A significant alteration in the sphingosine 1-phosphate signaling pathway was found in the fetal death group, with an increased expression of the specific receptor isoforms sphingosine 1-phosphate receptor 1, 3, and 4 (sphingosine 1-phosphate(1), sphingosine 1-phosphate(3), sphingosine 1-phosphate(4)) and of sphingosine kinase 2, 1 of the enzyme isoforms responsible for sphingosine 1-phosphate synthesis (P<.01). Conclusion: The present study confirmed a significantly increased expression of placental interleukin 6 and vascular endothelial growth factor receptor 2 mRNA, and for the first time showed an increased expression of sphingosine 1-phosphate receptors and sphingosine kinase 2 as well as a decreased expression of activin A and of selected ATP-binding cassette transporters, suggesting that multiple inflammatory and protective factors are deranged in placenta of fetal death.

BACKGROUND: Despite major advances in the pharmacologic treatment of hypertension in the nonpregnant population, treatments for hypertension in pregnancy have remained largely unchanged over the years. There is recent evidence that a more adequate control of maternal blood pressure is achieved when the first given antihypertensive drug is able to correct the underlying hemodynamic disorder of the mother besides normalizing the blood pressure values. OBJECTIVE: This study aimed to compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy following the baseline hemodynamic findings. STUDY DESIGN: This was a prospective multicenter study that included a population of women with de novo diagnosis of hypertensive disorders of pregnancy. A noninvasive assessment of the following maternal parameters was performed on hospital admission via Ultrasound Cardiac Output Monitor before any antihypertensive therapy was given: cardiac output, heart rate, systemic vascular resistance, and stroke volume. The clinician who prescribed the antihypertensive therapy was blinded to the hemodynamic evaluation and used as first-line treatment a vasodilator (nifedipine or alpha methyldopa) or a beta-blocker (labetalol) based on his preferences or on the local protocols. The first-line pharmacologic treatment was retrospectively considered hemodynamically appropriate in either of the following circumstances: (1) women with a hypodynamic profile (defined as low cardiac output [<= 5 L/min] and/or high systemic vascular resistance [>= 1300 dynes/second/cm(2)]) who were administered oral nifedipine or alpha methyldopa and (2) women with a hyperdynamic profile (defined as normal or high cardiac output [>5 L/min] and/or low systemic vascular resistances [<1300 dynes/second/cm(2)]) who were administered oral labetalol. The primary outcome of the study was to compare the occurrence of severe hypertension between women treated with a hemodynamically appropriate therapy and women treated with an inappropriate therapy. RESULTS: A total of 152 women with hypertensive disorders of pregnancy were included in the final analysis. Most women displayed a hypo- dynamic profile (114 [75.0%]) and received a hemodynamically appropriate treatment (116 [76.3%]). The occurrence of severe hypertension before delivery was significantly lower in the group receiving an appropriate therapy than in the group receiving an inappropriately treated (6.0% vs 19.4%, respectively; P=.02). Moreover, the number of women who achieved target values of blood pressure within 48 to 72 hours from the treatment start was higher in the group who received an appropriate treatment than in the group who received an inappropriate treatment (70.7% vs 50.0%, respectively; P=.02). CONCLUSION: In pregnant individuals with de novo hypertensive disorders of pregnancy, a lower occurrence of severe hypertension was observed when the first-line antihypertensive agent was tailored to the correct maternal hemodynamic profile.

Objectives: to describe the results of a pilot population -based perinatal mortality surveillance system, with regards to stillbirths; to study maternal, obstetric, and foetal characteristics, evaluating risk factors and understanding causes. Design: a cross-sectional study was conducted on incident cases of stillbirths collected by the surveillance system from July 2017 to June 2019 in three Italian Regions (Lombardy, Tuscany, and Sicily) Setting and participants: data on stillbirths, resulting from the in -hospital multidisciplinary audits, organised using the Significant Event Audit methodology, were analysed. According to the World Health Organization (WHO) definitions, the project identified stillbirths as foetuses born dead >= 28 weeks of gestation. The WHO International Classification of Diseases-Perinatal Mortality was used to categorise the causes of foetal death. Main outcomes measures: maternal characteristics, obstetric and foetal findings were investigated. Unadjusted relative risks and 95% confidence intervals were computed with respect to the background population. Finally, causes of death and contributing maternal conditions have been considered. Results: the maternity and neonatal units of the three participating Regions notified 520 stillbirths, of which 435 cases underwent to the multidisciplinary audit (83.7%); 40.0% of cases occurred in the gestational age range between 36 and 39 weeks. The risk of stillbirth was significantly increased in mothers with foreign citizenship (RR: 1.39; 95%CI: 1.13-1.71), multiple pregnancies (RR: 1.59; 95%CI 1.05-2.42), and pregnancies conceived with assisted reproductive technologies (RR: 2.15; 95%CI 1.45-3.19). The rate of congenital malformations was 6.0%. A diagnosis of foetal growth restriction was reported in 10.3% of cases, although the percentage of dead foetuses weighting <10 degrees centile was at least twice in almost all gestational age periods. Post -mortem and placental histological examinations were carried out in more than 70% and more than 90% of cases, respectively. Conclusions: the implementation of a population-based surveillance system with high participation rate of maternity units and the use of universally accepted definitions could improve the identification of stillbirth avoidable risk factors and potentially modifiable predisposing maternal conditions, highlighting issues of perinatal assistance in need of improvement.

Objective The Italian Association of Preeclampsia (AIPE) and the Italian Society of Perinatal Medicine (SIMP) developed clinical questions on maternal hemodynamics state of the art. Study Design AIPE and SIMP experts were divided in small groups and were invited to propose an overview of the existing literature on specific topics related to the clinical questions proposed, developing, wherever possible, clinical and/or research recommendations based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale were submitted to 8th AIPE and SIMP Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. Results More and more evidence in literature underlines the relationship between maternal and fetal hemodynamics, as well as the relationship between maternal cardiovascular profile and fetal-maternal adverse outcomes such as fetal growth restriction and hypertensive disorders of pregnancy. Experts agreed on proposing a classification of pregnancy hypertension, complications, and cardiovascular states based on three different hemodynamic profiles depending on total peripheral vascular resistance values: hypodynamic (>1,300 dynes·s·cm−5), normo-dynamic, and hyperdynamic (<800 dynes·s·cm−5) circulation. This differentiation implies different therapeutical strategies, based drugs' characteristics, and maternal cardiovascular profile. Finally, the cardiovascular characteristics of the women may be useful for a rational approach to an appropriate follow-up, due to the increased cardiovascular risk later in life. Conclusion Although the evidence might not be conclusive, given the lack of large randomized trials, maternal hemodynamics might have great importance in helping clinicians in understanding the pathophysiology and chose a rational treatment of patients with or at risk for pregnancy complications. Key Points

Abstract Background An effective strategy to reduce perinatal mortality requires an active surveillance system. This includes monitoring cases, organizing multidisciplinary local audits, conducting Confidential Enquiries, identifying avoidable factors, and facilitating changes in the healthcare system. In 2017, the Italian Obstetric Surveillance System launched the SPItOSS pilot Perinatal Surveillance System. The aim of this paper is to describe the results of the SPItOSS Confidential Enquiries on perinatal deaths focusing on the emergent critical aspects in obstetric and neonatal care, as well as on the healthcare facilities organization. Methods SPItOSS, a population-based surveillance system, collected and analysed incident perinatal deaths from July 2017 to June 2019 in three Regions encompassing 32.3% of Italian births. Cases were defined according to WHO definition as fetuses born dead ≥ 28 weeks of gestation and live newborn died within 7 days from birth. The International Statistical Classification of Diseases and related Health Problem-Perinatal Mortality was adopted for coding causes of death and contributing maternal and placenta-related conditions. Confidential Enquiries, prioritized according to perinatal deaths preventability, were conducted by expert committees at Regional and National level. Results A total of 830 incident perinatal deaths were notified, with 58.3% classified as antepartum, 4.3% as intrapartum, and 37.3% as neonatal deaths. According to the SPItOSS protocol, Confidential Enquiries evaluated only the most preventable deaths, including 19 intrapartum and 70 neonatal deaths. Of these, 43.8% were assessed as unavoidable with appropriate care; 29.2% as unavoidable with improvable care, and 15.7% as avoidable due to inappropriate care. Most intrapartum deaths were attributed to intrauterine hypoxia, while neonatal deaths recognized a multifactorial aetiology. Different aspects of inappropriate care were highlighted, such as failure to recognise maternal or fetal problems before labour, delayed or inappropriate neonatal resuscitation, and poor or suboptimal neonatal monitoring. Conclusions The SPItOSS Confidential Enquires provided insights for improving maternity and perinatal services. By targeting key areas of obstetric and neonatal care, the surveillance can generate recommendations and actions to prevent avoidable perinatal deaths.

BACKGROUND: To evaluate the levels of depression, state and trait anxiety, self efficacy, and self-esteem among women with high risk pregnancy due to previous adverse pregnancy outcomes (PAPOs) or pre-pregnancy diseases (PPD), before and after delivery, compared to controls.METHODS: An observational longitudinal study on psychological dimensions was conducted on 86 women attending a university referral centre for high risk pregnancy, by administering the Edinburgh Postnatal Depression Scale, the State and Trait Anxiety Inventory, the General Self-Efficacy Scale, and the Self-esteem Scale. A pre-test (in the third trimester of pregnancy) and a follow-up measurement session (one month after the delivery) were applied. PAPOs group, PPD group and controls were compared.RESULTS: The PAPOs group had higher levels of depression compared to the other groups, with above-threshold levels. However, a more relevant decrease in depression was found in the PAPOs group after delivery. Levels of self-efficacy and self-esteem were unexpectedly high during and after pregnancy in all the groups. CONCLUSIONS: A PAPO represents a risk factor for depression development during pregnancy, whereas a PPD seems to be less relevant in influencing affective dimensions. Surprisingly, all pregnant women, independently of the obstetric risk, showed high levels of self-efficacy and self-esteem.

Objectives To investigate the rate and outcome of emergency Cesarean delivery (CD) in women with placenta previa with or without placenta accreta spectrum disorders (PAS) and to elucidate the diagnostic accuracy of ultrasound in predicting emergency CD. Methods This was a secondary analysis of a multicenter prospective study involving 16 referral hospitals in Italy (ADoPAD study). Inclusion criteria were women with placenta previa minor (< 20 mm from the internal cervical os) or placenta previa major (covering the os), aged >= 18 years, who underwent transabdominal and transvaginal ultrasound assessment at >= 26 + 0 weeks of gestation. The primary outcome was the occurrence of emergency CD, defined as the need for immediate surgical intervention performed for emergency maternal or fetal indication, including active labor, cumulative maternal bleeding > 500 mL, severe and persistent vaginal bleeding such that maternal hemodynamic stability could not be achieved or maintained, or category-III fetal heart rate tracing unresponsive to resuscitative measures. The primary outcome was reported separately in the population of women with placenta previa and no PAS confirmed after birth and in those with PAS. The secondary aim was to report on the strength of association and to test the diagnostic accuracy of ultrasound in predicting emergency CD. Univariate, multivariate and diagnostic accuracy analyses were used to analyze the data. Results A total of 450 women, including 97 women with placenta previa and PAS and 353 with placenta previa only, were analyzed. In women with placenta previa and PAS, emergency CD was required in 20.6% (95% CI, 14-30%), and 60.0% (12/20) delivered before 34 weeks of gestation. The mean gestational age at delivery was 32.3 +/- 2.7 weeks in women undergoing emergency CD and 34.9 +/- 1.8 weeks in those undergoing elective CD (P < 0.001). Women undergoing emergency CD had a higher median estimated blood loss (2500 (interquartile range (IQR), 1350-4500) vs 1100 (IQR, 625-2500) mL; P = 0.012), mean units of blood transfused (7.3 +/- 8.8 vs 2.5 +/- 3.4; P = 0.02) and more frequent placement of a mechanical balloon (50.0% vs 16.9%; P = 0.002) compared with those undergoing elective CD. On univariate analysis, the presence of interrupted retroplacental space, interrupted bladder line and placental lacunae was more common in women not experiencing emergency CD. No comprehensive multivariate analysis could be performed in this subgroup of women. Ultrasound signs of PAS, including presence of interrupted retroplacental space, interrupted bladder line and placental lacunae, were not predictive of emergency CD. In women with placenta previa but no PAS, emergency CD was required in 31.2% (95% CI, 26.6-36.2%), and 32.7% (36/110) delivered before 34 weeks of gestation. The mean gestational age at delivery was lower in women undergoing emergency CD compared with those undergoing elective CD (34.2 +/- 2.9 vs 36.7 +/- 1.6 weeks; P < 0.001). Pregnancies complicated by emergency CD were associated with a lower birth weight (2330 +/- 620 vs 2800 +/- 480 g; P < 0.001) and had a higher risk of need for blood transfusion (22.7% vs 10.7%; P = 0.003) compared with those who underwent elective CD. On multivariate analysis, only placental thickness (odds ratio (OR), 1.02 (95% CI, 1.00-1.03); P = 0.046) and cervical length < 25 mm (OR, 3.89 (95% CI, 1.33-11.33); P = 0.01) were associated with emergency CD. However, a short cervical length showed low diagnostic accuracy for predicting emergency CD in these women. Conclusion Emergency CD occurred in about 20% of women with placenta previa and PAS and 30% of those with placenta previa only and was associated with worse maternal outcome compared with elective intervention. Prenatal ultrasound is not predictive of the risk of emergency CD in women with these disorders. (c) 2023 International Society of Ultrasound in Obstetrics and Gynecology.