Pregnant and postpartum women make up a small proportion of intensive care unit (ICU) admissions, but they require distinct, carefully adapted approaches to care. This review outlines these challenges and proposes general principles to address them, emphasising consultant-level multidisciplinary input and alignment with national standards for service organisation and escalation of care. Pregnancy-related physiological changes affect haemodynamics, ventilation, and renal function-all of which have implications for monitoring, treatment thresholds, and drug selection. The practical aspects of organ support are discussed, as well as imaging and contrast safety. It is emphasised that maternal stabilisation and timely critical diagnosis should take priority, and that pregnant women must not be disadvantaged in their access to life-saving interventions. The conditions that may lead to critical illness in obstetric patients are reviewed, with a discussion of the current evidence and clinical practice. Attention to psychological well-being and lactation support is underscored as an essential component of holistic recovery and long-term outcomes.
A negative birth experience can have profound and lasting consequences for women's health and family planning. Obstetric interventions have been associated with increased likelihood of a negative birth experience. However, the impact of accumulated and varying combination of interventions remains less understood. In this retrospective cohort study, we used data from 22,585 singleton births among 10,903 women (8705 primipara births, 13,880 multipara births) who participated in the Stress-And-Gene-Analysis (SAGA) study and had a record in the Icelandic Medical Birth Register, where information on obstetric interventions (induction, epidural analgesia, instrumental birth, episiotomy and caesarean section) were obtained. We used Poisson regression with robust standard errors to assess the association between number of interventions (0, 1, 2, or ≥3) and negative birth experience, calculating crude and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Among primiparous women, the prevalence of negative birth experiences increased stepwise with number of obstetric interventions, from 11.5% (no intervention) to 39.5% (≥3 interventions). Adjusted PRs were 1.94 (95%CI:1.751-2.20) with 1, 2.66 (2.36 - 3.00) with 2, and 3.40 (2.97-3.90) with ≥3 interventions, compared with no intervention. For multiparous women, the PRs followed a similar pattern but were slightly higher. In this population-based study, number of obstetric interventions was associated with a stepwise higher prevalence of negative birth experience among both primiparous and multiparous women. Combinations of obstetric interventions including instrumental birth or emergency cesarean section were most strongly associated with negative birth experience.
The requirement for regular maternal-fetal monitoring and clinical consultations has increased in recent years, placing a strain on obstetric services. In recent years, technology advancements have enabled the development of remote monitoring and teleconsultation strategies, aiming to provide care in the home setting. This cross-sectional survey seeks to understand the current state of home-based monitoring and teleconsultations across the United Kingdom (UK). A web-based survey was distributed to an obstetric representative in all UK National Healthcare Service (NHS) trusts. Survey questions consisted of multiple-choice and open questions surrounding four domains: (1) demographics, (2) home-based antenatal monitoring, (3) obstetric teleconsultations, and (4) advantages and disadvantages of home-based monitoring and teleconsultations. In total, 76 out of 145 (52.4%; 95% confidence interval [CI], 44.0-60.8 response rate) UK NHS trusts completed the survey. Any form of home monitoring and obstetric teleconsultations were provided in 61.8% (95% CI, 50.0-72.8) (47/76) and 68.4% (95% CI, 56.7-78.6) (52/76) of UK trusts, respectively. Secondary analysis demonstrated that remote monitoring was significantly more likely to be used in teaching versus non-teaching NHS trusts (P = 0.03). Blood pressure monitoring (45/47, 95.8%; 95% CI, 85.5-99.5) and chronic hypertension (41/47, 87.2%; 95% CI, 74.3-95.2) were the most common device and condition to use home monitoring, respectively. Teleconsultations were utilized most frequently for patients complicated with gestational diabetes (34/52, 65.4%; 95% CI, 50.9-78.0) and delivered via a telephone call (51/52, 98.1%; 95% CI, 89.7-100). High cost and lack of clinical support were cited as the most common implementation barriers by respondents not currently using these strategies. Patient convenience (42/76, 55.3%; 95% CI, 43.4-66.7 and 44/76, 57.9%; 95% CI, 46.0-69.1) and reduced hospital burden (38/76, 50%; 95% CI, 38.3-61.7 and 22/76, 28.9%; 95% CI, 19.1-40.5) were common advantages for home monitoring and teleconsultations, respectively. Compliance issues (23/76, 30.3%; 95% CI, 20.2-41.9 and 15/76, 19.7%; 95% CI, 11.5-30.5) and digital resource requirements (15/76, 19.7%; 95% CI, 11.5-30.5, and 18/76, 23.7%; 95% CI, 14.7-34.8) were frequently cited difficulties for both home monitoring and teleconsultations, respectively. This study describes the current state of remote monitoring and obstetric teleconsultation implementation across the UK, with survey respondents primarily derived from English maternity services. National frameworks are emerging and are vital to inform future digital standardization.
Maternal satisfaction is a widely used indicator for evaluating the quality of maternity services and is linked to important psychological and relational outcomes. In Italy, limited data have been published on women's childbirth experiences, generally showing high satisfaction, but highlighting areas needing improvement, such as communication and pain management, especially during emergency cesarean section or operative vaginal delivery. This study primarily aimed to assess women's overall evaluation of their labor and delivery experiences. Additionally, we examined sociodemographic and obstetric factors that may influence maternal satisfaction and explored satisfaction across specific experiential domains. This is an observational, cross-sectional, non-pharmacological, non-profit, monocentric study conducted between June and October 2024 at the Unit of Obstetrics and Maternal Fetal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. A total of 696 women were consecutively recruited during their postpartum hospital stay. Participants completed a pseudonymized questionnaire which consisted of three sections: sociodemographic data, obstetric history, and birth experience evaluation using a 5-point Likert scale. Maternal satisfaction was operationalized as a retrospective self-reported appraisal of care. We used logistic regression to estimate prevalence odds ratios (OR) and the corresponding 95% confidence intervals (CI) for the associations between dissatisfaction and selected maternal and obstetric factors. Overall, 85.3% (95% CI: 82.7%-88.0%) of women reported satisfaction with their labor and delivery experience. Previous childbirth was inversely associated with dissatisfaction (OR=0.53, 95% CI: 0.29-0.97). In contrast, higher maternal age (OR=1.05, 95% CI: 1.00-1.10), labor induction (OR=2.18, 95% CI: 1.31-3.61), and operative delivery (OR=3.37, 95% CI: 2.06-5.51) were positively associated with dissatisfaction. The main concerns reported by dissatisfied women included inadequate pain management, lack of perceived control, and insufficient emotional support. Despite high overall maternal satisfaction, relevant gaps persist in communication, emotional support, pain management, and perceived control during childbirth. Interventions promoting shared decision-making, structured communication, and systematic use of satisfaction surveys and birth plans may support a more woman-centered approach to maternity care, potentially improving both women's evaluation of care and the quality of intrapartum services.
Survival to reproductive age is common among women with congenital heart disease (CHD). We evaluated fetal and obstetric complications in a population-based cohort of women with CHD enrolled in Georgia (GA) Medicaid. We identified 3904 pregnancies (96.0% singleton) among 2267 women with CHD, ages 11-50 (49.2% Black; 76.3% urban), enrolled in GA Medicaid from 2008 to 2019. Diagnoses and outcomes were defined using International Classification of Diseases (ICD) codes. Associations between CHD anatomic group and fetal and obstetric outcomes were assessed using chi-square tests. Multivariate logistic regression models were adjusted for covariates, using isolated coronary anomalies as the reference group. Obstetric complications occurred in 36.2% of pregnancies and did not differ significantly by CHD anatomic group (p = 0.5301). Fetal complications were significantly more common in all CHD groups compared with coronary anomalies, including higher prematurity and fetal growth restriction (FGR) rates (prematurity: p < 0.0001; FGR: p = 0.0238). In multivariate analysis, complex right ventricular outflow tract (RVOT) defects, shunts, univentricular lesions, transposition of the great arteries (TGA), left-sided and right-sided valve lesions were associated with increased odds of fetal complications compared to coronary anomaly CHD [aOR, 95% CI: complex RVOT 4.85, 1.85-12.71; shunt 4.00, 1.56-10.26; univentricular: 3.65, 1.35-9.90; TGA: 3.64, 1.24-10.63; left-sided valve: 3.23, 1.26-8.31; and right-sided valve: 3.11, 1.19-8.12]. Pregnancies among women with CHD carry increased risk of prematurity and FGR rates across CHD anatomic groups compared with coronary anomalies. Close monitoring for fetal and obstetric complications is warranted regardless of CHD subtype, including those traditionally considered to have lower maternal risk.
Obstetric haemorrhage (OH), particularly postpartum haemorrhage, is a leading cause of maternal mortality in sub-Saharan Africa. Emergency medical services (EMS) play a critical role in early recognition, intervention and transport; however, evidence on EMS preparedness for OH remains limited. This study assessed the system-level preparedness of public-sector emergency care providers in KwaZulu-Natal (KZN) across four domains: administration, resources, training and response capacity. A concurrent convergent mixed-methods design was used. Quantitative data were collected using structured questionnaires (n = 417) and analysed descriptively. Qualitative data were obtained through semi-structured interviews (n = 10) and thematically analysed. Findings were integrated to identify convergence and divergence across data sources. Key gaps were identified across all four domains. Administrative weaknesses included inconsistent policy implementation and limited supervisory oversight. Resource constraints reflected ambulance shortages and variable access to essential equipment. Training gaps included limited hands-on obstetric exposure and variable practical skills on scene. Response capacity was affected by the absence of maternal-specific surge planning. Emergency medical services in KZN play a central role in the prehospital management of OH but operate within significant system-level constraints. Strengthening governance, improving fleet and equipment availability, expanding practical obstetric training and integrating maternal health into surge and disaster planning may enhance preparedness in KZN and similar resource-limited settings. This study provides evidence on EMS preparedness to manage obstetric haemorrhage, informing system strengthening and maternal emergency care planning.
Kenya has the 16th highest maternal mortality rate and the 58th highest infant mortality rate in the world. Most of these deaths are preventable and attributed to inadequate prenatal care. A chart audit at Africa Inland Church Kijabe Hospital revealed significant gaps in care at the initial prenatal visit. This project aimed to increase effective prenatal care for all new obstetric patients seen at the Maternal and Child Health Clinic to 75% within 8 weeks. This quality improvement initiative consisted of two core interventions implemented over four Plan-Do-Study-Act cycles. Each 2-week cycle was guided by a test of change, and the data were analyzed at the end of each cycle. The first core intervention was implementing a new obstetric standard of care, based on 32 evidence-based guidelines from the World Health Organization and the Kenya Ministry of Health, which were embedded into a standardized intake template at the initial prenatal visit. The second core intervention was implementing a pregnancy risk calculator, using the Alberta Antenatal Risk Assessment, to classify each new obstetric patient's pregnancy as low, moderate, or high risk. This project achieved its aim statement and increased effective prenatal care from 21% to 77% in 8 weeks. Implementing the standardized intake template increased the mean standard-of-care score from 42% to 83%, with the greatest improvements seen in documenting a complete medical history and ordering prenatal labs. The number of high- or moderate-risk pregnancies identified was 33%, providing an opportunity for timely referral to the high-risk pregnancy clinic. The tools used in this quality improvement initiative provided a low-cost method to promote high-quality prenatal care. The standardized intake template can be adapted to other countries and contexts; further studies are needed to evaluate its impact on birth outcomes. This is the first known report of the implementation of a pregnancy risk calculator in Kenya to identify high-risk pregnancies. Further research is needed to analyze its effectiveness and to develop and validate a pregnancy risk calculator for sub-Saharan Africa.
Immunological response to paternal antigens in semen and sperm has been implicated in the aetiology of preeclampsia. Although donor sperm conception has been associated with increased preeclampsia risk, evidence specifically regarding IVF with donor sperm remains limited. We aimed to assess whether pregnancies achieved via IVF with donor sperm are associated with a higher risk of preeclampsia or perinatal complications compared to IVF pregnancies using partner sperm. This prospective registry-linkage study included women undergoing IVF using donor versus partner sperm between 2009 and 2017 at the Reproductive Clinic of Karolinska University Hospital, Stockholm, Sweden. Data on demographics and IVF treatments were collected from the clinic's database, while obstetric data were obtained from the Swedish Medical Birth Register by linking individual records across the two databases. Compared with partner sperm, donor sperm was not associated with increased risk of preeclampsia. However, donor sperm was associated with an increased risk of 5-min Apgar score < 7 (OR 2.13, 1.21-3.78), but lower risks of preterm birth (OR 0.55, 0.35-0.86), preterm premature rupture of membranes (OR 0.35, 0.18-0.67), and low birth weight (OR 0.54, 0.33-0.88). Body mass index > 25 kg/m2 was associated with a higher rate of preeclampsia (aOR 2.20, 1.32-3.68). Our study does not support the hypothesis that sperm donation in IVF increases preeclampsia risk. However, donor sperm was associated with differences in obstetric and neonatal outcomes, suggesting that sperm source or related treatment characteristics may influence pregnancy outcomes beyond preeclampsia.
Structural racism and discrimination underlie disparities in maternal health outcomes in the US. Provider bias, racialized clinical decision-making, and institutional structures contribute to unequal experiences and outcomes faced by Black birthing people. Using a causal attribution framework, we examined obstetric care providers' beliefs, perceptions, and knowledge regarding causes of maternal health disparities. We conducted a mixed-methods study among 284 obstetric care providers (physicians and advanced practice providers) in Georgia from August 2023 to January 2024. A 72-item survey assessed beliefs and perceptions regarding maternal health disparities, color evasion, and empathy. Using scores for a question measuring agreement with the statement that provider behavior contributes to racial differences in maternal health care quality, we created two groups (high [≥ 5] and low [≤ 4] provider behavior attribution) and compared the distribution of survey responses between the groups. A subset of 26 survey respondents participated in seven virtual focus groups that used clinical vignettes to further explore beliefs. Integrating thematic and ideal-type analyses, this study identified emerging themes and provider typologies. Respondents (median age 41 years; 84.5% female) were mostly physicians (82.3%) and predominantly identified as white (42.0%), Hispanic (37.4%), or Black (13.9%). Compared to respondents with low provider behavior attribution scores (N = 168), those with high scores (N = 112) were more likely to identify as Black, report greater empathy, and acknowledge personal biases influencing patient care (p<.05 for all comparisons). Color evasion scores were high across both groups. Focus groups revealed three perceived drivers of disparities: structural and systemic factors (e.g., patient blame culture); organizational constraints (e.g., care discontinuity, burnout); and interpersonal dynamics (e.g., rapport building, "two victims" in adverse events). Five provider typologies emerged: advocacy is healthcare, helpless doctor, knowledge giver, empathy as advocacy, and evasion by communication. Findings suggest that providers may use color evasion and empathy to disguise personal bias and perpetuate racist stereotypes. The identified typologies suggest that providers use varying approaches to deflect responsibility for overcoming and addressing personal bias.
Standard postoperative care for major gynecologic and obstetric surgery traditionally involves a 48-hour observation period. However, extraordinary crises such as the COVID-19 pandemic and the 2023 Kahramanmaraş earthquake necessitated an accelerated 24-hour discharge protocol to preserve hospital capacity. This study aims to evaluate whether a 24-hour early discharge protocol is non-inferior to the conventional 48-hour standard regarding clinical complications. In this retrospective cohort study, data from 11,670 patients (2010-2024) were analyzed. Patients were categorized into Pandemic (n = 2,924) and Earthquake (n = 1,194) groups (24-hour discharge), and a Control group (n = 7,552; 48-hour discharge). Primary outcomes included surgical site infection (SSI), urinary tract infection (UTI), wound dehiscence, and hemorrhagic complications within 30 days. Non-inferiority was established for SSI (4.3% and 4.4% vs. 4.1%), UTI (3.5% and 3.6% vs. 3.3%), and wound dehiscence (1.4% and 1.3% vs. 1.3%). Multivariable regression confirmed that hospitalization duration was not an independent predictor of SSI (p > 0.500), whereas obesity (OR: 1.91; p < 0.001) was the primary risk factor. Hemorrhagic complication results remained inconclusive due to insufficient statistical power. A 24-hour postoperative discharge protocol is non-inferior to the 48-hour standard for most major complications following benign surgery. These findings suggest that patient-intrinsic factors, specifically BMI, drive infection risk more than the length of hospital stay.
In 1991 a statewide service for the management of pregnant women living with HIV (WLHIV) was established in Western Australia (WA). To review the maternal epidemiology and obstetric and neonatal outcomes for pregnancies in WLHIV under the care of this multidisciplinary management team since its inception. All ongoing pregnancies for WLHIV between 1991 and December 2022 were identified from interrogation of the state-wide multidisciplinary perinatal HIV management database. WLHIV with early pregnancy losses or who delivered outside of WA were excluded. Two hundred and thirty four viable pregnancies to 162 WLHIV occurred. Maternal ethnicity altered significantly; the rate of new cases of pregnancies in WLHIV for African and Southeast Asian women being 3.92 times (95% CI 1.22-12.60, p = 0.022) and 4.41 times higher (95% CI 1.37-14.25, p = 0.013) from 2007 to 2022, respectively, from those in 1998 to 2006. A significant decrease in HIV-exposed pregnancies occurred among Indigenous Australian women during these time periods (IRR 0.15, 95% CI 0.05 to 0.44, p = 0.001). Over time there was a significant reduction in the proportion of women with a detectable viral load at booking. Prior to 2007, 31 cases (72.1%) had a detectable viral load at booking compared with 68 (38.9%) from 2007 onwards (p < 0.001). Overall, an undetectable viral load at delivery was recorded for 88.3% (197/223). The vertical HIV transmission rate was very low, with one case (0.4%) reported. Most women formula fed their babies (94.5%). A state-wide multi-disciplinary service, combined with universal antenatal HIV screening, has been successful in preventing HIV MTCT in WA.
Existing literature suggests a link between migraine and various adverse pregnancy outcomes, but findings remain inconsistent. This study aimed to evaluate the association between pre-pregnancy migraine and obstetric outcomes. This retrospective cohort study used linked electronic health records from Clinical Practice Research Datalink (CPRD) GOLD and Hospital Episode Statistics (HES) maternity data. We included women aged 15-50 years in England with singleton deliveries between 2000 and 2019. Deliveries from women with a recorded migraine diagnosis before pregnancy were matched 1:1 by maternal age to those without migraine. Logistic regression models, adjusted for demographic and clinical factors, were used to examine associations with preterm birth, low birth weight, small for gestational age (SGA), mode of delivery, and stillbirth. The cohort included 428,217 deliveries from 317,016 women, comprising 46,560 (10.9%) migraine-exposed deliveries and an equal number of matched controls. No significant association was found between pre-pregnancy migraine and preterm birth (aOR 1.04(0.99-1.09)), although migraine appeared to have a protective effect against very preterm birth (aOR 0.83(0.73-0.95)). Pre-pregnancy migraine was associated with increased odds of iatrogenic preterm birth (aOR 1.10, 95% CI: 1.04-1.18), but not spontaneous preterm birth (aOR 0.97, 95% CI: 0.91-1.03). Migraine was associated with a significant increase in the odds of pre-eclampsia (aOR 1.17 (95% CI 1.07-1.27)). There were no notable associations with low birth weight (1500-2500 g) (aOR 1.02, 95% CI: 0.95-1.09), very low (1000-1500 g) or extremely low birth weight (< 1000 g), SGA (aOR 0.96, 95% CI: 0.89-1.03), or stillbirth (aOR 1.00, 95% CI: 0.81-1.24). No significant association was seen between migraine and elective caesarean section (aOR 1.04, 95% CI: 0.99-1.09). Pre-pregnancy migraine was associated with increased odds of iatrogenic preterm birth and pre-eclampsia. Associations with other outcomes were small and uncertain. Further research is needed to understand the mechanisms underlying these findings and their clinical relevance.
Maternal attention-deficit/hyperactivity disorder (ADHD) is increasingly recognised during the reproductive years, often with delayed diagnosis. Although ADHD has been linked to perinatal complications, it remains unclear whether risks reflect ADHD itself, comorbidity, vulnerability, behaviours, and medication use. We examined associations between maternal ADHD, stratified by diagnosis before and after childbirth, and ADHD medication exposure during pregnancy with a range of pregnancy, childbirth, and neonatal outcomes. We conducted a nationwide register-based cohort study, including 741,905 singleton live births in Denmark (2010-2022). Childbirths were classified by maternal ADHD diagnosis before childbirth (n = 12,859), after childbirth (n = 15,683), and no ADHD (n = 713,363). Among women diagnosed before childbirth, ADHD medication exposure was classified; no exposure (n = 10,118), first-trimester (n = 1,129) and continued (n = 1,612) based on prescription-timing. Analyses were preformed using Poisson GEE, accounting for repeated births and adjusting for sociodemographics, psychiatric history, and somatic comorbidity. Maternal ADHD diagnosed before childbirth was associated with preterm childbirth (aRR 1.13, 95% CI 1.04-1.22; aRR 1.29, 95% CI 1.07-1.56) and low birthweight (aRR 1.19, 95% CI 1.09-1.30). Early pregnancy haemorrhage was modestly elevated for ADHD diagnosed before and after childbirth (aRR 1.15, 95% CI 1.08-1.25; aRR 1.14, 95% CI 1.07-1.22). ADHD diagnosed after childbirth was associated with infection (aRR 1.19, 95% CI 1.11-1.27), hyperemesis (aRR 1.23, 95% CI 1.13-1.34), and Apgar score < 7) (moderate aRR 1.48, 95% CI 1.09-2.01; severe aRR 1.32, 95% CI 1.09-1.59). ADHD medication in pregnancy (vs. unmedicated) was associated with gestational hypertension (first-trimester aRR 1.57, 95% CI 1.21-2.02; continued aRR 1.39, 95% CI 1.01-1.91). Maternal ADHD, whether diagnosed before childbirth or postpartum, was associated with small increases in selected obstetric and neonatal risks after adjustment for relevant sociodemographic and clinical factors. Continued use of ADHD medication was significantly associated with gestational hypertension only. However, these findings should be interpreted with caution due to the potential for residual confounding, including confounding by indication.
Neuraxial anaesthesia is recommended as the preferred technique for caesarean section, and the proportion performed under general anaesthesia is increasingly regarded as a quality indicator. Previous national audits in the Czech Republic and Slovakia demonstrated a reduction in general anaesthesia rates between 2011 and 2015; however, contemporary population-level data are lacking. OBAAMA-COV was a prospective, cross-sectional national audit conducted in November 2022 across maternity units in the Czech Republic and Slovakia. Consecutive caesarean sections were recorded using a structured electronic registry. Population weighting based on official national statistics was applied to generate representative estimates of anaesthetic technique distributions and reported indications. The analyses were descriptive. A total of 2,270 caesarean sections were recorded from 94 centres. Population-weighted estimates corresponded to 2,068 procedures in the Czech Republic and 1,205 in Slovakia. Overall general anaesthesia rates were 33.9% and 31.3%, respectively. In elective procedures, general anaesthesia was used in 23.0% (95% CI 19.9-26.4) in the Czech Republic and 24.9% (20.6-29.7) in Slovakia; in emergency procedures, rates were 45.4% (42.1-48.8) and 36.8% (31.8-42.1), respectively. Maternal preference was the leading reported indication in elective cases (approximately 60-63% across audit cycles), whereas urgency predominated in emergency settings. Rapid sequence induction with tracheal intubation was used in most cases; difficult intubation occurred in approximately 2% of cases, and no aspiration was recorded. Umbilical arterial pH values were comparable between general anaesthesia and neuraxial techniques. These population-weighted data demonstrate a persistent divergence from contemporary European standards. General anaesthesia for caesarean section remains common in both countries, plateauing rather than declining since 2015. The continued reliance on general anaesthesia-driven by maternal preference in elective procedures and by urgency in acute settings-suggests an important contribution of organisational and sociocultural factors beyond strictly clinical indications. ClinicalTrials.gov (NCT04912791), registered June 2, 2021.
To describe obstetric and perinatal outcomes of pregnant women with advanced maternal age (AMA) conceiving through in vitro fertilization (IVF) technology. A single-center prospective observational study was conducted between January and December 2024. All women aged 40 and older who conceived via IVF were included. Participants underwent regular prenatal follow-up in a maternal-fetal unit, including standardized maternal clinical assessment and fetal ultrasound evaluation. A subgroup analysis (40-44-year-old subgroup vs. ≥45-year-old subgroup) was also conducted to identify potential differences in obstetric and perinatal outcomes within our study population. A total of 128 pregnant women were included. Nearly half were primigravid (n = 60, 46.88%) and 71 pregnancies resulted from oocyte donation (55.47%). Obstetric complications observed in this cohort included gestational diabetes mellitus (n = 3, 2.34%), hypertensive disorders (n = 6, 4.76%) preterm premature rupture of membranes (n = 11, 8.59%), preterm intrauterine growth restriction (n = 7, 5.56%) and preterm delivery (n = 15, 11.72%). It is noteworthy that these last three outcomes mentioned were observed significantly more frequently in the subgroup aged over 45 years. Cesarean delivery was performed in 62 cases (49.6%). Regarding neonatal outcomes, the median birth weight was 3,028 g and the median umbilical cord pH was 7.29. Eight newborns (6.45%) required admission to intensive care unit. Postnatal comorbidities were identified in 14 infants, with respiratory complications being the most frequent (12/14). In this cohort of women of AMA following IVF, several obstetric and neonatal complications were observed. Additionally, the subgroup analysis revealed that PPROM, preterm IUGR and preterm delivery, lower neonatal weight and respiratory complications were significantly more frequent among women aged 45 or older. These findings provide descriptive clinical data regarding pregnancies in this specific population, which remains relatively underrepresented in the literature. Given the single-center design of the study, further research, including studies with appropriate comparison groups and larger sample size conducted across multiple centers, are needed to better clarify the individual and combined contributions of AMA and IVF to these outcomes.
The global transformations in health care system, directed from reactive medicine to proactive and preventive model bring to the forefront issues of protection of female health. The health of woman is not only fundamental basis, but also key factor of social economic well-being of society, demographic stability and health of future generations. The traditional fragmented model of provision of obstetric gynecological care, focused mainly on treatment of already occurred pathologies and pregnancy management, demonstrates its inefficiency in the context of modern challenges: increase of chronic noncommunicable diseases, psycho-emotional loads and need of integration of reproductive health into general context of well-being of woman at all stages of her life. In the Russian Federation, the problem of modernization of obstetric gynecological service and, in particular, women consultations, is especially acute. Historically, The historically established system is often criticized for bureaucratization, insufficient focus on prevention and disparity between various levels of medical care. In this regard, emergence and implementation of new regional standards, in particular, metropolitan standard of obstetric gynecological care and Centers of Female Health is unique case requiring detailed scientific analysis and comparison with international advanced experience. The actuality of the study is conditioned by increasing need in developing new paradigm of medical care support of women, built on principles of complexity, continuity, personalization and orientation on prevention. The Centers of Female Health, integrating large spectrum of services, from screenings and diagnostics to psychological support and training programs, are considered by world community as gold standard of organization of such care. Глобальные трансформации в системе здравоохранения, устремленные от реактивной медицины к проактивной, превентивной модели, выдвигают на первый план вопросы охраны женского здоровья. Здоровье женщины является не только фундаментальной основой, но и ключевым фактором социально-экономического благополучия общества, демографической стабильности и здоровья будущих поколений. Традиционная фрагментированная модель оказания акушерско-гинекологической помощи, сфокусированная преимущественно на лечении уже возникших патологий и ведении беременности, демонстрирует свою неэффективность в контексте современных вызовов: росте хронических неинфекционных заболеваний, психоэмоциональных нагрузок и необходимости интеграции репродуктивного здоровья в общем контексте благополучия женщины на всех этапах жизни. В Российской Федерации проблема модернизации акушерско-гинекологической службы, в частности женских консультаций, стоит особенно остро. Исторически сложившаяся система часто критикуется за бюрократизацию, недостаточный фокус на профилактике и разобщенность различных уровней медицинской помощи. В этой связи появление и внедрение новых региональных стандартов, в частности столичного стандарта акушерско-гинекологической помощи и Центров женского здоровья, представляет собой уникальный кейс, требующий детального научного анализа и сравнения с передовым мировым опытом. Актуальность данного исследования обусловлена нарастающей потребностью в создании новой парадигмы оказания медицинской помощи женщинам, построенной на принципах комплексности, непрерывности, персонализации и ориентации на профилактику. Центры женского здоровья, интегрирующие в себе широкий спектр услуг, от скринингов и диагностики до психологической поддержки и образовательных программ, рассматриваются мировым сообществом как золотой стандарт организации такой помощи.
Dystocia in jennies is rare and requires prompt diagnosis and intervention to preserve maternal health. This report aimed to describe a case of fetal dystocia in a crossbred primiparous jenny presented after approximately seven hours in the second stage of parturition, highlighting the obstetric diagnosis, therapeutic approach, and clinical outcome. Obstetric examination revealed anterior presentation, right lateral position, bilateral carpal joint flexion, head deviation, fetal death and fetopelvic disproportion. Following sacrococcygeal epidural anesthesia, corrective obstetric maneuvers were attempted but were unsuccessful. Partial fetotomy of the thoracic limbs was performed, followed by cephalic repositioning using an obstetric hook, allowing vaginal fetal extraction. No additional birth canal injuries were observed. Despite the lack of specific fetotomy instruments, technical adaptations allowed successful completion of the procedure. The jenny showed satisfactory clinical recovery, remaining standing with spontaneous food and water intake. Postural correction associated with partial fetotomy effectively resolved dystocia while preserving maternal integrity.
There is a paucity of studies on the incidence and predictors of thrombotic antiphospholipid syndrome (APS) after pregnancy in patients with recurrent pregnancy loss (RPL) and antiphospholipid antibodies (aPL). This prospective study aimed to assess the long-term prognosis, including the occurrence of thrombosis and associated risk factors, in patients with aPL-positive RPL and related obstetric APS manifestations. We examined patients with RPL and related obstetric APS manifestations who were positive for lupus anticoagulant (LA) based on APTT, Russell's viper venom time (RVVT), or β2glycoprotein I-dependent anticardiolipin antibody (β2GPIaCL) IgG and visited Nagoya City University Hospital from 1994 to 2019. A survey was conducted in 2024 in which patients were asked to complete a questionnaire on the development of APS manifestations based on the American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria. Data of 259 of 285 patients (90.5%) who responded to the questionnaire were analysed. The median follows-up duration was 17 (4.6-31.1) years. Cumulatively, 9.6% (25/259) of patients with aPLs and 15.7% (18/114) of those with obstetric APS experienced thrombotic APS. LA-APTT, LA-RVVT, and　β2GPIaCL IgG were independent predictors of thrombotic APS, with area under the curve values of 0.85 (0.73-0.97), 0.93 (0.87-0.99), and 0.80 (0.68-0.93), respectively. A history of intrauterine foetal death, early-onset preeclampsia, no live birth, thrombosis and complications of systematic lupus erythematosus, and persistent aPL were predictive of thrombotic APS. Patients with RPL and aPL who exhibit the identified risk factors should undergo subsequent follow-up after pregnancy. Further research is required to investigate the potential for thrombosis prevention.
Dilapan-S, a synthetic osmotic dilator used for pre-induction cervical ripening, has proven to be as effective as the Foley balloon in terms of vaginal versus cesarean delivery and has been associated with increased patient satisfaction. Nevertheless, its ability to lower cesarean rates and its cost-effectiveness remain poorly studied. To estimate the likelihood that synthetic osmotic dilators reduce cesarean deliveries and to evaluate their health system costs (2026 US$) and incremental cost-effectiveness compared to the Foley balloon during cervical ripening. Secondary Bayesian analyses were conducted using data from the single-center DILAFOL randomized controlled trial, which enrolled 419 parturients at ≥37 weeks' gestation with singleton pregnancies undergoing labor induction with an unfavorable cervix. Participants were randomized to receive synthetic osmotic dilators (n = 208) or a Foley balloon (n = 209) for cervical ripening. A Bayesian logistic regression model was used to estimate the probability of a reduced cesarean delivery rate with synthetic osmotic dilators. Health system costs were evaluated using Bayesian generalized linear models. The incremental cost-effectiveness ratio (ICER) was derived from these models using neutral priors, assuming no treatment effect. In intent-to-treat analysis, synthetic osmotic dilators had an 89% probability of reducing cesarean delivery compared to the Foley balloon (mean absolute risk difference, -5.0% (95% credible interval [CrI], [-12.8 to 2.7). Mean total obstetric cost per patient was $10,198 for synthetic osmotic dilators and $10,176 for Foley (RR, 1.00; 95% CrI, 0.94 - 1.06). Although synthetic osmotic dilators cost $399 per patient, this was largely offset by an 85% probability of reduced hospital costs ($8,771 vs. $9,081; RR, 0.97; 95% CrI, 0.90-1.03) and 99% probability of reduced physician costs ($1,028 vs. $1,094; RR, 0.94; 95% CrI, 0.89-0.99). The ICER of synthetic osmotic dilators versus Foley was $439 per cesarean delivery prevented (95% CrI, -$51,813 to $57, 697]), with 42% of posterior draws falling in the dominant quadrant (cost-saving and more effective). The probability of cost-effectiveness rose from 47% at $0 willingness-to-pay threshold to 85% at $15,000 per cesarean delivery prevented. Subgroup analyses suggested that economic benefits were most favorable among patients aged <35 years and nulliparous parturients, in whom the posterior probability of dominance was 52% and 39%, respectively. Despite its higher material cost, synthetic osmotic dilators likely reduced cesarean delivery rates with minimal impact on total health system costs and a favorable cost-effectiveness profile. These findings, which do not account for neonatal costs or future pregnancy outcomes, suggest that osmotic dilators represent good value in obstetric care, particularly among younger and nulliparous patients. Further validation across obstetric settings is warranted.
In low- and middle-income countries, including South Africa, caesarean section (CS)-associated maternal complications, some of which are attributed to lack of skill and training, are of concern. The performing and teaching of CSs are not standardised in South Africa. This study aimed to identify the comprehensive steps, including those that are implicit, of a CS, according to South African experts. A modified three-round Delphi survey method was used. The steps were divided into preoperative, intraoperative and postoperative. Invitations were sent to South African obstetric experts for voluntary participation. The aimed sample size was 15, and consensus was reached according to the confidence intervals (CIs) calculated from the Likert scale results. For the first two rounds, a seven-point Likert scale was used. In round three, only steps that had not reached consensus yet were presented to the panel as essential, substeps or excluded. Invitations were sent to 44 experts: 28 (64%) completed round one, 20 (45%) round two and 19 (43%) round three. Sixty-six steps were identified after three rounds: 9 essential/14 substeps preoperatively, 14 essential/15 substeps intraoperatively and 5 essential/9 substeps postoperatively. South African obstetric experts recommended 66 steps for performing a CS. This comprehensive list could contribute to the standardisation and training of CSs, which may help increase the safety and quality of CSs, especially in low- and middle-income settings where junior doctors perform most of these surgeries, often without supervision.