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Objective: To evaluate the clinical features and perinatal outcomes of antenatally diagnosed fetuses with omphalocele and gastroschisis. Material and Methods: This was a retrospective, single-center, cohort study of prenatally diagnosed fetuses with omphalocele and gastroschisis followed-up and delivered at a university hospital. Demographic, pregnancy, birth and perinatal outcomes were compared between gastroschisis and omphalocele. Results: A total of 75 fetuses with omphalocele and 21 cases with gastroschisis were evaluated. The mean maternal age of women carrying a fetus with omphalocele was significantly higher than the women with gastroschisis (p=0.001). Associated structural anomalies were found in 53.3% and 4.7% of fetuses with omphalocele and gastroschisis, respectively (p<0.001). The rate of chromosomal anomaly was 8.3% in pregnancies with omphalocele. In liveborn pregnancies, the mean gestational age at delivery and birth weight did not differ between the study groups. Time to postoperative oral intake, duration of parenteral nutrition and length of hospital stay were significantly longer in babies with gastroschisis than omphalocele (p<0.01). Rates of termination, intrauterine, neonatal and infant death of fetuses with omphalocele were 25.3%, 6.7%, 10.7% and 2.7% respectively. Time to postoperative oral intake, duration of parenteral nutrition and duration of hospitalization were significantly longer in babies with complex compared to simple gastroschisis (p<0.01). Survival rates were 95.2%, 82.9% and 20% in fetuses with gastroschisis, isolated and non-isolated omphalocele, respectively. Conclusion: Associated structural and chromosomal anomalies were significantly more common in fetuses with omphalocele compared to those with gastroschisis. Prognosis of fetuses with omphalocele depended on the associated structural and chromosomal anomalies, whereas bowel compromise was the main determining factor in gastroschisis. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the platelet parameters and their prognostic value for perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). Methods: This retrospective study involved 180 participants, 90 pregnant women with SLE and 90 healthy pregnant women. Clinical and demographic variables including routine first-trimester neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet parameters such as platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT) were compared between the groups. The perinatal outcomes of the whole study group were also compared. Results: SLE patients had lower leukocyte (p = 0.001), lymphocyte (p = 0.001) and platelet counts (p = 0.018), higher PDW (p = 0.002), MPV (p = 0.001), NLR (p = 0.008) and PLR (p = 0.015) and lower PCT (p = 0.015) than the control group. The groups had no significant difference in hemoglobin levels (p = 0.936). SLE patients had higher rates of cesarean section (p = 0.002), small for gestational age (SGA) (p = 0.019) and stillbirth (p = 0.017) and lower birth weight (p = 0.001) than the control group. PCT was a significant predictor of stillbirth with a cut-off value of 0.21, sensitivity of 64.3% and specificity of 83.3% (AUC: 0.843, p < 0.001). Conclusion: Pregnant women with SLE have altered platelet parameters and increased inflammatory markers compared to healthy pregnant women. PCT is a simple and useful marker for predicting stillbirth risk in SLE pregnancies. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between maternal sepsis during pregnancy and poor pregnancy outcome and to identify risk factors for poor birth outcomes and adverse perinatal events. Methods: We linked the Taiwan Birth Cohort Study (TBCS) database and the Taiwanese National Health Insurance Database (NHID) to conduct this population-based study. We analysed the data of pregnant women who met the criteria for sepsis-3 during pregnancy between 2005 and 2017 as the maternal sepsis cases and selected pregnant women without infection as the non-sepsis comparison cohort. Sepsis during pregnancy and fulfilled the sepsis-3 definition proposed in 2016. The primary outcome included low birth weight (LBW, < 2500 g) and preterm birth (< 34 weeks), and the secondary outcome was the occurrence of adverse perinatal events. Results: We enrolled 2,732 women who met the criteria for sepsis-3 during pregnancy and 196,333 non-sepsis controls. We found that the development of maternal sepsis was highly associated with unfavourable pregnancy outcomes, including LBW (adjOR 9.51, 95% CI 8.73–10.36), preterm birth < 34 weeks (adjOR 11.69, 95%CI 10.64–12.84), and the adverse perinatal events (adjOR 3.09, 95% CI 2.83–3.36). We also identified that socio-economically disadvantaged status was slightly associated with an increased risk for low birth weight and preterm birth. Conclusion: We found that the development of maternal sepsis was highly associated with LBW, preterm birth and adverse perinatal events. Our findings highlight the prolonged impact of maternal sepsis on pregnancy outcomes and indicate the need for vigilance among pregnant women with sepsis. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to detect an increase in nuchal translucency (NT) measurement among our patients attending our clinic for 11-14 weeks of control and to examine the perinatal and postnatal outcomes of pregnant women who were recommended an invasive fetal procedure but refused it. Methods: 107 pregnant women between 11-14 weeks of gestation who were evaluated in our center from 2018 to 2021 and who rejected invasive procedures were included. Patients opting for follow-up and delivery at another facility were excluded from the study. The study groups were categorized into 3 groups based on NT values, regardless of gestational age: 1st Group 2.5-3.4 mm, 2nd Group 3.5-4.5 mm, and 3rd Group>4.5 mm. Fetal ultrasound scans were conducted during the antenatal period, with detailed examinations postnatally. Results: Abnormal ultrasound findings were detected in 11.2% of fetuses, with a higher prevalence in groups exhibiting greater NT increases. While chromosomal anomaly was seen in 13% of all fetuses, Group 2 (NT 3.5-4.5mm) had the highest percentage (33.3%). The highest right and healthy birth rates were found in group 1 (91.8%), inversely proportional to the increase in NT. Conclusion: Increased NT values appear to be associated with increased rates of structural anomalies and adverse perinatal outcomes. Although chromosomal anomalies are associated with NT increase, a direct proportional relationship between the two remains undetermined. [ABSTRACT FROM AUTHOR]

Apert syndrome is an inherited condition with autosomal dominant transmission. It is also known as acrocephalosyndactyly type I, being characterized by a syndrome of craniosynostosis with abnormal head shape, facial anomalies (median hypoplasia), and limb deformities (syndactyly, rhizomelic shortening). The association can suspect the prenatal diagnosis of these types of anomalies. The methodology consisted of revising the literature, by searching the PubMed/Medline database in which 27 articles were selected and analyzed, comprising 32 cases regarding the prenatal diagnosis of Apert syndrome. A series of ultrasound parameters, the anatomopathological abnormalities found, the obstetric results, and the genetic tests were followed. The distribution of imaging results (US, MRI) identified in the analyzed cases was as follows: skull-shaped abnormalities were evident in 96.8% of cases, facial abnormalities (hypertelorism 43.7%, midface hypoplasia 25%, proptosis 21.8%), syndactyly in 87.5%, and cardiovascular abnormalities in 9.3%. The anomalies detected by the ultrasound examination of the fetus were confirmed postnatally by clinical or gross evaluation or imaging. The management of these cases requires an early diagnosis, an evaluation of the severity of the cases, and appropriate parental counseling. [ABSTRACT FROM AUTHOR]

Background: Vitamin D deficiency is associated with several obstetric complications in singleton pregnancy. The aim of this study was to assess whether vitamin D levels affect the outcomes of twin pregnancy and if targeted supplementation can improve perinatal outcomes. Methods: The serum vitamin D levels of 143 women with twin pregnancies were measured during their first trimester. Those with insufficient (10–30 ng/mL; IL group) or severely deficient (<10 ng/mL, DL group) vitamin D levels were supplemented. In the third trimester, vitamin D levels were reassessed. Perinatal outcomes of the IL and DL groups were compared with those of patients with sufficient levels (>30 ng/mL, SL group) since the beginning of pregnancy. Results: Women in the IL and DL groups had a higher incidence of hypertensive disorders of pregnancy (HDP) compared to the SL group (24.8% and 27.8% vs. 12.5%, p = 0.045): OR = 1.58 for the IL group and 1.94 for the DL group compared to the SL group. In patients whose vitamin D levels were restored after supplementation, HDP incidence was lower than in patients who remained in the IL or DL groups (23.4% vs. 27.3%) but higher than those who were always in the SL group (12.5%). Conclusions: Insufficient or severely deficient levels of vitamin D in the first trimester are associated with an increased risk of HDP in twin pregnancy. The beneficial effect of targeted vitamin D supplementation in reducing HDP seems limited. [ABSTRACT FROM AUTHOR]

Objective This study investigated the clinical outcome of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). Study Design International Peace Maternal and Child Health Hospital of Shanghai ultrasound database was investigated to identify all MCDA delivered from January 2013 to December 2017. After identifying 43 pairs of MCDA twins with sIUGR and 282 pairs of normal MCDA twins, we compared clinical outcomes between the two groups. Results Compared with normal twins, sIUGR fetuses had significantly shorter gestational age at delivery, smaller average birth weight of both twins, more significant intertwin difference in birth weight, lower Apgar scores, and higher intrauterine fetal demise (IUFD) rate, and smaller placental weight. The rate of abnormal umbilical cord insertions and abnormal blood flow in the ductus venosus (DV) and middle cerebral artery (MCA) is significantly higher in the sIUGR group. In addition, the subtype analysis of sIUGR groups indicated the poorest outcomes in type II with no significant difference between type I and III. Conclusion MCDA twins with sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with abnormal umbilical cord insertions and blood flow in the DV and MCA. Clinical outcomes differed among the three types of sIUGR, with type II having the worst prognosis and the highest IUFD rate. Key points sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with blood flow of the DV and MCA. sIUGR with type II has the worst prognosis and the highest IUFD rate. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries—for instance in pregnancies with breech presentation—obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m2) in comparison to women with a BMI of below 25 kg/m2. Methods: Based on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi2 testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study. Results: Fetal morbidity was not different when patients with a BMI of ≥ 25 kg/m2 (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m2 (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi2 coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups. Conclusions: Obesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the elevation of HbA1c before full-term delivery in single pregnancy with normal 75 g- Oral glucose tolerance test (OGTT) screening and its association with adverse perinatal outcomes. Methods: From January to December 2022, an observational prospective study was conducted in a Single centre in China. 365 single pregnant women with normal OGTT were included in the study. HbA1c was measured during OGTT and before full-term delivery, and perinatal outcomes were collected. Participants' pre-delivery HBA1c values were analyzed and perinatal outcomes were compared. Logistic regression analysis was used for independent risk factors associated with elevated pre-delivery HbA1c ≥ 6.0%. The predictive value and truncation value were analyzed by ROC curve. Results: 15.89% (58/365) of the Participants had a pre-delivery HBA1C value ≥ 6.0%. The incidence of neonatal asphyxia (13.79%, vs. 3.45%, vs. 2.26%, P = 0.007) and amniotic fluid fecal staining (29.31%, vs. 12.64%, vs. 12.03%, P = 0.004) were significantly increased in this group. The independent risk factor associated with pre-delivery HBA1c ≥ 6.0% was the fasting blood glucose(FBG) value of OGTT (OR = 51.308, 95% CI 12.93–203.67, P < 0.01) and the HBA1c value measured during OGTT (OR = 3.608, 95% CI 1.432–9.151, P = 0.007). When FBG was < 4.18 mmol/L and HBA1c was < 5.51%, The accuracy of predicting the pre-delivery HBA1c < 6.0% was 98.2%. Conclusions: 15.89% of the single pregnancy with normal OGTT had HbA1c ≥ 6.0% before full-term delivery, and they had an increased incidence of neonatal asphyxia and amniotic fluid fecal staining. When the FBG ≥ 4.18 mmol/l or the HBA1c ≥ 5.51% during the OGTT screening, repeated OGTT were recommended in late pregnancy. [ABSTRACT FROM AUTHOR]

Problem: This study aimed to evaluate the predictive value of delta neutrophil index (DNI), a peripheral blood parameter, on perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). Method of Study: One hundred eighty‐one participants, 78 pregnant women with SLE, and 103 healthy pregnant women were included in this retrospective study. Peripheral blood parameters including neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and DNI taken in the first trimester were compared between groups. Results: NLR, PLR, and DNI were significantly higher in the SLE group (p = 0.027, p = 0.007, p = 0.0001, respectively). The same parameters were not found to be significant in determining disease activity in pregnant women with SLE (p > 0.05). When the predictive value of DNI for SGA in pregnancies with SLE was evaluated by receiver operating characteristic curve (ROC), the area under the ROC curve (AUC) was 0.666 (95% CI; 0.544–0.788, p = 0.018) with 84.6% sensitivity, 53.8% specificity, 56.0% PPV, and 78.1% NPV at a cut‐off value of 0.16. The predictive value of DNI according to ROC for stillbirth in pregnancies with SLE was AUC 0.731 (95% CI: 0.539–0.923, p = 0.019) with a cut‐off value of 0.17, sensitivity of 90%, specificity of 51.5%, PPV of 58.5%, and NPV of 87.2%. Conclusions: Although DNI's prediction of SGA and stillbirth in pregnant women with SLE is encouraging, it needs more evidence from prospective studies with larger series. [ABSTRACT FROM AUTHOR]

Background: High risk pregnancy is one which is complicated by risk factor that adversely affects the maternal outcome or perintal outcome or both. The antepartum fetal surveillance of high risk pregnancies with Cardiotocographycan effectively help for reducing perintal mortality and morbidity. One of the biophysical methods which is being used extensively in the management of high risk pregnancy is (CTG) Cardiotocography. Aims & Objectives: 1. To assess the benefit of cardiotocography to improve the fetal outcome in high risk pregnancy. 2. To find out the suitable time and mode of delivery of the fetus at risk. Materials and Methods: This is a prospective observational study conducted at Government General Hospital attached to Government Medical College, Kadapa from the month of July 2023 to the month of june 2024. Study includes 100 high risk pregnancies with singleton fetus of 32 weeks or more than 32 weeks of gestation CTG performed within 3 days prior to delivery will be considered for fetal outcome. In all cases detailed history, clinical and obstetric examination USG and alntepartum, intrapartum CTG will be performed and decision for mode of delivary is planned and different Perinatal outcome are assessed as 1 min and 5 min apgar score and NICU admissions. Results: Among 100 high risk pregnancies included in the study the most common risk factor is preeclampsia (25%) followed by oligos (16%). The incidence of non-reactive intrapartum CTG are 33 in number (33%). Out of 100, 43 underwent cesarean section, 54 delivered vaginally and 3 delivered instrumentally. Out of 100 cases one minute apgar was 5-7 in 41 subjects, 8-10 in 58 subjects and <4 in 1 subject. Among the study group 30 (30%) had NICU admissions. Conclusion: CTG is simple, cheap, non invasive cost effective with less training & best screening test to identity patients at a greater risk of intrapartum fetal hypoxia. CTG is effective tool to evaluate fetal condition, to detect fetal distress and there by early intervention to improve the Perinatal outcome. [ABSTRACT FROM AUTHOR]

We aimed to estimate the associations between coronavirus disease 2019 (COVID-19) vaccination during pregnancy and the risks of adverse perinatal outcomes. We performed a literature search in PubMed, Web of Science and Embase to identify eligible studies published up to 24 September 2023, yielding 39 included studies. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated with a random effects model. The pooled results showed that COVID-19 vaccination during pregnancy (any type or dose of COVID-19 vaccination during any trimester) was not associated with an increased risk of adverse perinatal outcomes. In particular, COVID-19 vaccination in the third trimester was associated with a decreased risk of preterm birth (<37 weeks) (RR 0.85 [95% CI 0.74 to 0.98]), 5-min Apgar <7 (RR 0.87 [95% CI 0.78 to 0.97]) and neonatal intensive care unit (NICU) admission (RR 0.90 [95% CI 0.86 to 0.95]). The inverse associations were also found in analysis of one-dose vaccination during pregnancy and the risk of miscarriage (RR 0.83 [95% CI 0.72 to 0.96]) and preterm birth (<37 weeks) (RR 0.90 [95% CI 0.80 to 1.00]) and two-dose vaccination during pregnancy and the risk of NICU admission (RR 0.86 [95% CI 0.76 to 0.96]). COVID-19 vaccination during pregnancy does not increase the risk of negative outcomes for the mother or baby. [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections, and perinatal outcomes of fetuses with ventriculomegaly (VM), also to evaluate the role of fetal magnetic resonance imaging (MRI) in detecting associated intracranial anomalies. Methods: Retrospective cohort study of 149 prenatally diagnosed pregnancies with fetal VM. VM was classified as mild (Vp = 10–12 mm), moderate (Vp = 12.1–15 mm), and severe (Vp > 15 mm). Fetal MRI was performed to 97 pregnancies. Results: The incidences of an associated CNS, non-CNS, chromosomal anomaly, genetic abnormality and fetal infection were 42.3%, 11.4%, 6.1%, 2.1% and 1.3%, respectively. Fetal MRI identified additional CNS anomalies in 6.7% of cases, particularly in severe VM. The incidences of perinatal outcomes were 18.8% termination of pregnancy, 4% intrauterine and 8.1% neonatal or infant death. The rates of fetuses alive at > 12 months of age with neurological morbidity were 2.6%, 11.1% and 76.9% for mild, moderate and severe isolated VM, respectively. Conclusion: The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. Mild to moderate isolated VM generally have favorable outcomes. Fetal MRI is particularly valuable in fetuses with isolated severe VM. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods: Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results: The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53–43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52–38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34–4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions: Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the significance of cerebro‐placento‐uterine ratio CPUR, a new Doppler index, and fetal cardiac parameters (Mod MPI, EFT) in early–onset preeclampsia (EOPE) and to examine whether these parameters are related to perinatal outcome. Study design: Forty participants diagnosed with EOPE (preeclampsia cases diagnosed before 34 weeks of gestation) and 40 healthy pregnant women were included in this study. Demographic data were recorded. Doppler parameters such as middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (Ut‐A), and left modified myocardial performance index (Mod–MPI) and epicardial fat thickness (EFT) were measured. Cerebroplacental ratio (CPR) was determined by dividing MCA pulsatility index (PI) by UA PI. CPUR was calculated as the ratio of CPR to mean UtA–PI (CPUR = CPR/UtA–PI). All parameters were compared between the EOPE and control groups. Correlation tests were used to examine the relationship between Doppler parameters and perinatal outcome. p values less than 0.05 were considered statistically significant. Results: The pulsatility index of the middle cerebellar artery, CPUR and CPR values were statistically lower in the EOPE group than in the control group (p = 0.002; p = <0.001; p = <0.001; respectively). No statistical differences were found between groups for isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), left mod‐MPI, EFT (p = 0.117; p = 0.093; p = 0.398; p = 0.882; p = 0.202, respectively). Umbilical artery Doppler pulsatility index (PI), mean uterine artery Doppler pulsatility index (PI), were higher in the EOPE group than in the control group (p = 0.006; and p = <0.001, respectively). The CPUR value for predicting EOPE was ≤1.3652 with 74. 4% sensitivity and 94.9% specificity. Positive correlations were found between CPUR, CPR, and some neonatal parameters. Conclusion: CPUR, a new index combining fetal and uterine Doppler indices, may add contribution to predict adverse perinatal outcome and EOPE. [ABSTRACT FROM AUTHOR]

Purpose: The association between birth order and adverse perinatal outcomes has been well studied in twin pregnancies. However, little is known about the differences in immediate perinatal outcomes as well as long‐term hospitalization of the offspring in triplet pregnancies according to their birth order. As such, we aimed to assess the differences in immediate perinatal outcomes and long‐term hospitalizations among triplets by their birth order. Methods: In a retrospective hospital‐based cohort study, immediate perinatal outcomes and long‐term hospitalizations were compared among triplet siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological, and infection‐related hospitalizations. Generalized estimation equation (GEE) models were used to control for confounders. Kaplan–Meier survival curves were used to compare cumulative long‐term hospitalization incidences and Cox proportional hazards models were performed to control for confounders. Results: The study included 117 triplet deliveries. Rates of small for gestational age (SGA) infants increased linearly by birth order (6.0%, 7.7%, and 15.4% for the first, second, and third siblings, respectively; p‐value for trends = 0.035). Using a GEE model controlling for maternal age, being born third in a triplet pregnancy was independently associated with SGA (third vs. first sibling, adjusted OR 3.0, 95% CI 1.38–6.59, p = 0.005). No significant differences in cardiovascular, respiratory, neurological, and infection‐related hospitalizations were noted among the first, second, and third siblings. Likewise, using Kaplan–Meier survival analyses, no significant differences in the cumulative incidence of long‐term pediatric hospitalizations were noted between the siblings. In Cox proportional hazards models, controlling for weight and gender, birth order in a triplet pregnancy did not exhibit an association with long‐term hospitalizations of the offspring. Conclusion: Despite the association between birth order and SGA, birth order in triplets does not seem to have an impact on the risk for long‐term offspring hospitalization. [ABSTRACT FROM AUTHOR]

Background: Purpose Aim of our study was to compare the prognostic value of the Umbilicalto-Cerebral ratio (UCR) directly to the Cerebroplacental ratio (CPR) in the prediction of poor perinatal outcomes in pregnancies complicated by Fetal Growth Restriction (FGR). Methods: A retrospective study was carried out on pregnant women with either a small-forgestational-age (SGA) fetus or that were diagnosed with FGR. Doppler measurements of the two subgroups were assessed, and the correlation between CPR, UCR, and relevant outcome parameters was evaluated by performing linear regression analysis, binary logistic analysis, and receiver operator characteristic (ROC) curves. Outcomes of interest were mode of delivery, acidosis, preterm delivery, gestational age at birth as well as birthweight and centiles. Results: Boxplots and Scatterplots illustrated the different distribution of CPR and UCR leading to deviant correlational relationships with adverse outcome parameters. In almost all parameters examined, UCR showed a higher independent association with preterm delivery (OR: 5.85, CI 2.23-15.34), APGAR score<7 (OR: 3.52; CI 1.58-7.85) as well as weight under the 10th centile (OR: 2.04; CI 0.97-4.28) in binary logistic regression compared to CPR, which was only associated with preterm delivery (OR: 0.38; CI 0.22-0.66) and APGAR score<7 (OR: 0.27; CI 0.06-1.13). When combined with different ultrasound parameters to differentiate between SGA and FGR during pregnancy, odds ratios for UCR were highly significant compared to odds ratios for CPR (OR: 0.065, 0.168-0.901; p=0.027; OR: 0.810, 0.369-1.781; p=0.601). ROC curves plotted for CPR and UCR showed almost identical moderate prediction performance. Conclusion: These findings indicate that the UCR should be prospectively examined as a prognostic tool while keeping the statistical characteristics and challenges of reversing the ratio in mind. [ABSTRACT FROM AUTHOR]

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Purpose: To evaluate the type of umbilical‐portal anastomosis in late‐onset fetal growth restriction (LO‐FGR) and appropriate for gestational age (AGA) fetuses. To investigate the impact of the type of umbilical‐portal anastomosis on the adverse outcomes in LO‐FGR. Method: This study observed 150 pregnancies with AGA fetuses and 62 pregnancies with fetuses with LO‐FGR. In each case, the point of reference for measuring the abdominal circumference was established. The type of umbilical‐portal anastomosis was evaluated as T‐shaped, X‐shaped, and H‐shaped according to the shape of main portal vein and portal sinus. Incidences of the type of umbilical‐portal anastomosis in AGA and LO‐FGR fetuses were evaluated. Results: T‐shaped anastomosis was the most common (56.7%) in the AGA group and X‐shaped (66.1%) in the LO‐FGR group. In LO‐FGR, T‐shape anastomosis was significantly lower and X‐shape anastomosis was significantly higher than AGA (p < 0.001). X‐shaped anastomosis was associated with LO‐FGR and the RR was 2.3 (95% CI 1.5–3.6; p < 0.001). Incidences of admission to NICU and emergency C/S for fetal distress were higher in fetuses with X ‐shaped anastomosis in the LO‐FGR (p < 0.05). Conclusion: X‐shaped umbilical‐portal anastomosis have a prognostic significance in LO‐FGR fetuses. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to analyze the morphological findings in the placenta of coronavirus disease-2019 (COVID-19)-positive women in correlation with the severity of infection, elevated inflammatory markers, gestational age at diagnosis and perinatal outcomes. Materials and methods: This is a prospective observational study of 66 singleton placentas of COVID-positive pregnant women over a period of 18 months. Clinical details, inflammatory markers, and perinatal outcomes were collected and analyzed in correlation with placental morphology. Results: Out of 66 pregnancies, 57 (86.3%) culminated in live births, of which 23 (40%) were small for gestation (SGA). Out of 66 cases, 9 (13.7%) experienced complications involving fetal demise intrauterine fetal death (IUFD). Based on the increase in inflammatory markers and gestational age at infection, the pregnancies were analyzed with regard to fetal outcome. Out of 66 pregnancies, 26 (39.4%) had moderate to marked elevation of two or more inflammatory markers. Fetal outcomes in these pregnancies were IUFD (34.6%), SGA (34.6%), appropriate for gestation (AGA) (26.9%) and neonatal death (ND) (3.8%). In women with elevated markers, 20% fetal or neonatal mortality was noted when the infection occurred in the third trimester whereas it was 100% when the infection occurred in the second trimester. All pregnancies affected in the third trimester and without an increase in markers (n = 40) resulted in live birth. The most significant placental finding observed was chronic inflammatory pathology (80%), followed by maternal vascular malperfusion (MVM) with or without fetal vascular malperfusion (FVM) (75.7%), and massive perivillous fibrin deposition (MPVFD) (12%). Conclusion: This study reemphasizes that in maternal COVID, the gestational age at infection, elevated inflammatory markers and severity of placental lesions could explain the perinatal outcomes. [ABSTRACT FROM AUTHOR]

To investigate the clinical outcomes and Doppler patterns changes in monochorionic diamniotic (MCDA) twins with selective fetal growth restriction (sFGR). We retrospectively analyzed 362 sFGR cases from January 2010 to May 2016 at a single tertiary referral center. The Doppler waveforms of umbilical artery end-diastolic flow were collected, and all neonates were subjected to an early neonatal brain scan. A total of 66/100 (66 %) type I cases were stable, whereas 25/100 (25 %) cases changed to type II and 9/100 (9 %) changed to sFGR complicated twin-twin transfusion syndrome (TTTS). A total of 48.9 % (22/45) sFGR cases were complicated with polyhydramnios and 30.4 % (7/23) sFGR cases were complicated with oligohydramnios, both of which were progressed to sFGR with TTTS. Mild cerebral injury was significantly associated with Doppler flow abnormalities, earlier gestational age at delivery and type of sFGR diagnosis. Severe cerebral injury was significantly associated with gestational age at delivery (31.6 vs. 34.1, p=0.002) and larger birthweight discordance (43.9 vs. 29.3 %, p=0.011). Doppler patterns in sFGR can gradually change, with important consequences with regard to management and outcomes. Along with abnormal Doppler findings, earlier occurrence of sFGR and delivery are associated with subsequent neonatal cerebral injury. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy‐associated gynecological cancer (PAGC) refers to cancers of the ovary, uterus, fallopian tube, cervix, vagina, and vulva diagnosed during pregnancy or within 12 months postpartum. We aimed to describe the incidence of, and perinatal outcomes associated with, invasive pregnancy‐associated gynecological cancer. Material and methods: We conducted a population‐based historical cohort study using linked data from New South Wales, Australia. We included all women who gave birth between 1994 and 2013, with a follow‐up period extending to September 30, 2018. Three groups were analyzed: a gestational PAGC group (women diagnosed during pregnancy), a postpartum PAGC group (women diagnosed within 1 year of giving birth), and a control group (women with control diagnosis during pregnancy or within 1 year of giving birth). We used generalized estimation equations to compare perinatal outcomes between study groups. Results: There were 1 786 137 deliveries during the study period; 70 women were diagnosed with gestational PAGC and 191 with postpartum PAGC. The incidence of PAGC was 14.6/100 000 deliveries and did not change during the study period. Women with gestational PAGC (adjusted odds ratio [aAOR] 6.81, 95% confidence interval [CI] 2.97–15.62) and with postpartum PAGC (aOR 2.65, 95% CI 1.25–5.61) had significantly increased odds of a severe maternal morbidity outcome compared with the control group. Babies born to women with gestational PAGC were more likely to be born preterm (aOR 3.11, 95% CI 1.47–6.59) and were at increased odds of severe neonatal complications (aOR 3.47, 95% CI 1.45–8.31) compared with babies born to women without PAC. Conclusions: The incidence of PAGC has not increased over time perhaps reflecting, in part, the effectiveness of cervical screening and early impacts of human papillomavirus vaccination programs in Australia. The higher rate of preterm birth among the gestational PAGC group is associated with adverse outcomes in babies born to these women. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the safety and effectiveness of oocyte vitrification by comparing the clinical pregnancy and perinatal outcomes between transfer cycles of vitrified oocytes and those of vitrified embryos. Methods: A retrospective cohort study was conducted to analyze the clinical data of patients who underwent cleavage-stage embryo transfer at the Department of Reproductive Medicine between January 2011 and June 2021. Seventy-seven transfer cycles of fresh cleavage-stage embryos developed from vitrified-thawed oocytes (oocyte vitrification group) and 2170 transfer cycles of vitrified-thawed cleavage-stage embryos developed from fresh oocytes (embryo vitrification group) were included. Further, 293 cases were selected from the embryo vitrification group after applying propensity score matching at 1:4. The primary outcomes were miscarriage rate, live birth rate, and neonatal birth weight. Results: No statistically significant differences were observed in the baseline data, pregnancy, perinatal outcomes, or neonatal outcomes for either singleton or twin births between the two groups after matching. Backwards stepwise regression was used to analyze the length of gestation. The age of female participants (β = − 0.410, 95% CI = − 1.339 ~ − 0.620, P < 0.001) had a statistically significant effect. Conclusion: Oocyte vitrification results in similar clinical pregnancy and perinatal outcomes as does embryo vitrification; hence, it is a relatively safe assisted reproductive technique. [ABSTRACT FROM AUTHOR]

Introduction: Foetal growth restriction (FGR), is a condition that occurs due to various reasons. It is an important cause of foetal and neonatal morbidity and mortality. It has been defined as a rate of foetal growth that is less than the growth potential of that specific infantor as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age. It has been found to be associated with a variety of adverse perinatal outcomes. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycaemia, polycythaemiaetc. The likely long-term complications that are prone to develop when FGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps etc. Methods: This cross-sectional study included all growth restricted babies born in the department of Obstetrics and Gynecology at Government Medical College, IMCH Kozhikodeduring the study period and their mothers. Multiple pregnancy with growth restriction were excluded from the study. Babies born outside IMCH but being referred to IMCH were also excluded. Socio -demographic and fetomaternal characteristics were collected after getting consent. Maternal data regarding socio-demographic variables including age, domicile (rural/urban), socio-economic status, data regarding gestational age, nature of ANC, past obstetric history including parity. Results: Perinatal mortality rate was 64.2/1000 in growth restricted babies born to normotensive mother group. The stillbirth rate was 36.6/1000 in growth restricted babies born to normotensive mother group. Fetal growthrestriction occurred more in rural womencompared to urban women. Women below poverty line had more fetal growth restriction compared to the women above poverty line and the difference was statistically significant. Early neonatal mortality rate was 28/1000 live IUGR babies in normotensive group. Conclusion: Mothers belonging to low socio-economic status have high risk of delivering babies with growth restriction. This is because of inadequate dietary intake, increased physical activity, passive smoking, increased rate of infections and low educational levels leading to decreased awareness regarding health care facilities. [ABSTRACT FROM AUTHOR]

Objective: Radiofrequency ablation (RFA) is the preferred approach for selective reduction in complex monochorionic (MC) multiple pregnancies owing to the ease of operation and minimal invasiveness. To optimize the RFA technique and reduce the risk of adverse pregnancy outcome resulting from the heat‐sink effect of RFA therapy, we used an innovative RFA method, in which an electrode needle was expanded incrementally and stepwise. This study aimed to assess the efficacy and safety profile of this novel multistep incremental expansion RFA method for selective fetal reduction in MC twin and triplet pregnancies. Methods: This was a single‐center retrospective cohort study of all MC multiple pregnancies undergoing RFA between March 2016 and October 2022 at our center. The multistep RFA technique involved the use of an expandable needle, which was gradually expanded during the RFA procedure until cessation of umbilical cord blood flow was achieved. The needle used for the single‐step RFA method was fully extended from the start of treatment. Results: In total, 132 MC multiple pregnancies underwent selective reduction using RFA, including 50 cases undergoing multistep RFA and 82 cases undergoing single‐step RFA. The overall survival rates were not significantly different between the multistep and single‐step RFA groups (81.1% vs 72.3%; P = 0.234). Similarly, the rates of preterm prelabor rupture of the membranes within 2 weeks after RFA, procedure‐related complications, spontaneous preterm delivery and pathological findings on cranial ultrasound, as well as gestational age at delivery and birth weight, did not differ between the two groups. However, there was a trend towards a prolonged procedure‐to‐delivery interval following multistep RFA compared with single‐step RFA (median, 109 vs 99 days; P = 0.377). Moreover, the fetal loss rate within 2 weeks after RFA in the multistep RFA group was significantly lower than that in the single‐step RFA group (10.0% vs 24.4%; P = 0.041). The median ablation time was shorter (5.3 vs 7.8 min; P < 0.001) and the median ablation energy was lower (10.2 vs 18.0 kJ; P < 0.001) in multistep compared with single‐step RFA. There were no significant differences in neonatal outcomes following multistep vs single‐step RFA. Conclusions: Overall survival rates were similar between the two RFA methods. However, the multistep RFA technique was associated with a lower risk of fetal loss within 2 weeks after RFA. The multistep RFA technique required significantly less ablation energy and a shorter ablation time compared with single‐step RFA in selective fetal reduction of MC twin and triplet pregnancies. Additionally, there was a trend towards a prolonged procedure‐to‐delivery interval with the multistep RFA technique. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Adolescent pregnancies give rise to high maternal and fetal risk. In our study, we aimed to compare the obstetric and neonatal outcomes of adolescent and non-adolescent pregnancies. Methods: This study included pregnant women who gave birth between 2018 and 2021 at Necmettin Erbakan University Faculty of Medicine, Obstetrics and Gynaecology Department. The study included 15 to 19-year-old pregnant women, and the control group was 20 to 34, in which age-related complications are known to be the lowest. Multiple pregnancies decreased birth weight and increased preterm delivery risk, so they were excluded from the study, along with patients with incomplete data. Participants’ socio-demographic and obstetric characteristics were retrospectively reviewed and determined by analyzing delivery records and patient files. The data was analyzed using the SPSS 26, whereas age, gestational diabetes, pre-eclampsia and APGAR scores were correlated using Pearson or Spearman correlation analyses. The study used 0.05 p-value. Results: The age, gravidity, parity, abortion and educational level of adolescent pregnancies were significantly lower than in the normal age group (p=0.001 for all parameters). The rates of pre-eclampsia, gestational diabetes and preterm prelabor rapture of membranes were lower in adolescent pregnancies (p=0.044, p=0.010, p=0.044, respectively), while the rates of fetal growth restriction and fetal distress were higher (p=0.016 and p=0.010). The rate of vaginal delivery was lower and the rate of vaginal delivery with episiotomy was higher in adolescent pregnancies (p<0.05). There were significant correlations between age, gestational diabetes and pre-eclampsia. ROC analysis showed that the risk of complications in adolescent pregnancies varies with age and is higher in pregnancies under 18.5 years. Conclusion: Adolescent pregnancies differ from those of normal age in some parameters of maternal and neonatal outcomes. However, it can be seen that adolescent pregnancies, especially late adolescent pregnancies, can have outcomes that are comparable to those of normal age groups. [ABSTRACT FROM AUTHOR]

Background: Despite pregnancy's hypercoagulable state, the correlation between inherited thrombophilia and thrombotic adverse pregnancy outcomes remains uncertain. The objective of this study was to determine the prevalence of inherited thrombophilic polymorphisms among asymptomatic pregnant individuals and to examine their potential correlation with adverse perinatal outcomes. Methods: in this single-center prospective study, 105 healthy pregnant women were included. Genotyping was conducted for factor V Leiden (FVL), prothrombin gene mutation, methylenetetrahydrofolate reductase enzyme (MTHFR) C677T, MTHFR A1298C, and plasminogen activator inhibitor-1 (PAI-1), alongside the assessment of protein C (PC), protein S (PS), and antithrombin (AT) levels. The study analyzed the association between inherited thrombophilic polymorphisms and pregnancy complications linked to placental insufficiency, such as gestational hypertension (GH), preeclampsia (PE), intrauterine death (IUD), fetal growth restriction (FGR), and placental abruption. Results: The prevalence of identifiable thrombophilic polymorphism mutations was 61.9% (95% confidence interval—CI 52.4–70.8%), with the most common single mutation being PAI-1 4G/5G (12/105, 11.4%, 95% CI 6.4–18.5). The most frequent combined mutation was heterozygosity for MTHFR C677T and PAI-1 (12/105, 11.4%, 95% CI 6.4–18.5). Notably, no FVL homozygous carriers or single homozygous and heterozygous carriers for prothrombin polymorphisms were found. Additionally, no deficiencies in PC and AT were detected among participants. Except for homozygosity for PAI-1, none of the studied polymorphisms demonstrated a significant association with pregnancy complications linked to placental insufficiency. Conclusions: The asymptomatic carriers of inherited thrombophilic polymorphisms do not have an increased risk of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective Understanding the reflections of prematurity is necessary for the management of neonatal complications. We focused on the impact of prematurity and related "maternal risk factors/obstetric complications" on buccal cells of the neonates via evaluation of the Wnt/β-catenin signaling pathway and apoptosis. Study Design This study consisted of "early preterm neonates (EPN) (≤34th gestational week [gw]) (n = 36)," "late preterm neonates (LPN) (34th– < 37th gw) (n = 46)," and "term neonates (control) (≥37th gw) (n = 56)." Cohort was also subclassified according to the presence of maternal risk factors, obstetric complications, and neonatal complications. Wnt/β-catenin signaling and caspase-3 activation pathways were studied immunocytochemically. Results Wnt/β-catenin signaling positivity was statistically more frequent at buccal smears of the EPN and LPN groups compared with controls (p < 0.001). The cutoff for gestational age at delivery in receiver operating characteristic curve with the best balance of sensitivity (67.4%) and specificity (67.3%) was 35.8th gw for determining the reduction of Wnt/β-catenin signaling positivity (p < 0.001). The study demonstrated that obstetric complications significantly affected the activity of signaling, while maternal risk factors do not have any effect on Wnt/β-catenin signaling pathway (p = 0.003 and p = 0.828, respectively). This study also demonstrated a significant relationship between Wnt/β-catenin signaling pathway and the presence of neonatal complications (p = 0.015). Conclusion Dynamic characteristics of buccal cells are influenced by prematurity and related obstetric and neonatal problems. Buccal smear is a good tool to investigate the impact of prematurity and obstetric problems on perinatal outcome. Key Points Neonatal buccal cells are affected by prematurity and related obstetric/neonatal problems. 35.8th gw is critical for determining the reduction of Wnt/β-catenin signaling positivity. Obstetric and neonatal complications significantly related to Wnt/β-catenin signaling activity. [ABSTRACT FROM AUTHOR]

Aim: To evaluate placental pathology in term and post-term births, investigate differences in clinical characteristics, and assess the risk of adverse neonatal outcome. Methods: This prospective observational study included 315 singleton births with gestational age (GA) > 36 weeks + 6 days meeting the local criteria for referral to placental histopathologic examination. We applied the Amsterdam criteria to classify the placentas. Births were categorized according to GA; early-term (37 weeks + 0 days to 38 weeks + 6 days), term (39 weeks + 0 days to 40 weeks + 6 days), late-term (41 weeks + 0 days to 41 weeks + 6 days), and post-term births (≥ 42 weeks + 0 days). The groups were compared regarding placental pathology findings and clinical characteristics. Adverse neonatal outcomes were defined as 5-minute Apgar score < 7, umbilical cord artery pH < 7.0, admission to the neonatal intensive care unit or intrauterine death. A composite adverse outcome included one or more adverse outcomes. The associations between placental pathology, adverse neonatal outcomes, maternal and pregnancy characteristics were evaluated by logistic regression analysis. Results: Late-term and post-term births exhibited significantly higher rates of histologic chorioamnionitis (HCA), fetal inflammatory response, clinical chorioamnionitis (CCA) and transfer to neonatal intensive care unit (NICU) compared to early-term and term births. HCA and maternal smoking in pregnancy were associated with adverse outcomes in an adjusted analysis. Nulliparity, CCA, emergency section and increasing GA were all significantly associated with HCA. Conclusions: HCA was more prevalent in late and post-term births and was the only factor, along with maternal smoking, that was associated with adverse neonatal outcomes. Since nulliparity, CCA and GA beyond term are associated with HCA, this should alert the clinician and elicit continuous intrapartum monitoring for timely intervention. [ABSTRACT FROM AUTHOR]

Background: After the outbreak of COVID-19, a huge part of the health care services was dedicated to preventing and treating this disease. In case of COVID-19 infection, severe COVID-19 is reported more in pregnant individuals. Afterward, Vaccination against SARS-CoV-2 became a hot topic due to known effects in preventing severe COVID-19 during pregnancy. Vaccination of pregnant individuals started in August 2021 with the Sinopharm vaccine in Iran. The aim of current study was to determine the incidence of perinatal outcomes in women who were vaccinated during pregnancy. Method: This retrospective cohort study included 129,488 singleton births from March 21, 2021, until March 21, 2022, in Tehran, Iran. The data was obtained from the Iranian Maternal and Neonatal (IMaN) Network and the Maternal Vaccination Registry. Adverse perinatal outcomes investigated in this study include preterm birth, extremely preterm birth, low birth weight, very low birth weight, intrauterine growth restriction, stillbirth, neonatal intensive care unit admission, congenital anomaly, neonatal death and low 5-minute Apgar score. The risk of all perinatal outcomes was evaluated using multiple logistic regression. The analysis was done using STATA version 14. Results: Of all 129,488 singleton births included in this study, 17,485 (13.5%) were vaccinated against SARS-CoV-2 (all with Sinopharm (BBIBP-CorV)). The exposure to the Sinopharm vaccine during pregnancy caused a significant decrease in the incidence of preterm birth (P =0.006, OR=0.91 [95% CI, 0.85 to 0.97]), extremely preterm birth (P =<0.001,OR=0.55 [95% CI, 0.45 to 0.66]), and stillbirth (P =<0.001, OR=0.60 [95% CI, 0.47 to 0.76]). Exposure to vaccination during the first trimester was associated with an increased risk of preterm birth (P =0.01, OR=1.27 [95% CI, 1.04 to 1.55]) Maternal vaccination during pregnancy was not associated with an increased risk of other adverse perinatal outcomes included in this study. Conclusion: The finding of this population-based study indicated no adverse pregnancy outcome due to vaccination with the Sinopharm vaccine during the second and third trimesters of pregnancy. Overall risk of adverse pregnancy outcomes were lower in the vaccinated individuals compared to the unvaccinated group. Also, vaccination during the first trimester was associated with an increased risk of preterm birth. [ABSTRACT FROM AUTHOR]

To evaluate the fetal ductus arteriosus anomalies diagnosed by fetal echocardiography. The perinatal outcomes and associated cardiac and genetic anomalies are also explored. The fetal echocardiography records of 2366 fetuses were evaluated retrospectively. Thirty-seven pregnancies prenatally diagnosed with ductus arteriosus anomalies and evaluated after delivery were enrolled in the study. Perinatal and obstetric outcomes were analyzed. The incidence of ductus arteriosus anomaly in our series was 1.5% (37/2366). The most frequent ductus arteriosus anomaly detected was right-sided ductus arteriosus followed by aneurysm, constriction and bilateral ductus arteriosus with an incidence of 51.3%, 27.1%, 18.9% and 2.7%, respectively. There were 19 fetuses with right-sided ductus arteriosus, of which 15 had tetralogy of Fallot. There were 2 chromosomal anomalies (22q11 microdeletion) in this group. Of the 7 fetuses with ductus arteriosus constriction, 3 (3/7, 42.9%) died in-utero. There were 2 (2/10, 20%) neonatal deaths due to hypoplastic left heart syndrome in the ductus arteriosus aneurysm group. Various types of ductus arteriosus anomalies can be diagnosed prenatally. Perinatal outcomes mostly dependent on the type of the ductus arteriosus anomaly and accompanying cardiac malformations. [ABSTRACT FROM AUTHOR]

Background: Omphalocele and gastroschisis are the most frequent congenital developmental abdominal wall defects. Prenatal diagnosis of omphalocele and gastroschisis is critical in the management of the pregnancy, affording patients the option of termination. This study aims to evaluate the prenatal diagnosis and postnatal outcomes of omphalocele and gastroschisis cases. Materials and Methods: The cases of gastroschisis and omphalocele diagnosed prenatally and followed up at our university were evaluated retrospectively between January 2019 and January 2022. Maternal demographic and clinical characteristics and perinatal outcomes were compared between the cases. Results: This study evaluated 42 omphalocele and nine gastroschisis cases. All gastroschisis cases were isolated (p =.001). Additional anomalies were present in 61.9% of omphalocele cases. While two patients with gastroschisis refused the invasive procedure, the genetic results of the others were normal. The karyotype was abnormal in 42.9% of omphalocele cases (p =.008). Half of the omphalocele cases were terminated, and 38.1% (n = 8) of the terminated omphalocele cases were trisomy 18. The coexistence of multiple system anomalies and cystic hygroma was high in the terminated cases. In all cases of gastroschisis, only the intestines protruded from the abdominal wall into the amniotic fluid. The number of survivors of omphalocele was 23.8%. The median hospital stay was 25 and 14 days for gastroschisis and omphalocele, respectively. Conclusion: Prenatal diagnosis of omphalocele and gastroschisis is critical in pregnancy management. The presence of associated anomalies determines the prognosis of omphalocele and gastroschisis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of intrahepatic cholestasis of pregnancy (ICP) with gestational diabetes mellitus (GDM) on perinatal outcomes and establish a prediction model of adverse perinatal outcomes in women with ICP. Methods: This multicenter retrospective cohort study included the clinical data of 2,178 pregnant women with ICP, including 1,788 women with ICP and 390 co-occurrence ICP and GDM. The data of all subjects were collected from hospital electronic medical records. Univariate and multivariate logistic regression analysis were used to compare the incidence of perinatal outcomes between ICP with GDM group and ICP alone group. Results: Baseline characteristics of the population revealed that maternal age (p < 0.001), pregestational weight (p = 0.01), pre-pregnancy BMI (p < 0.001), gestational weight gain (p < 0.001), assisted reproductive technology (ART) (p < 0.001), and total bile acid concentration (p = 0.024) may be risk factors for ICP with GDM. Furthermore, ICP with GDM demonstrated a higher association with both polyhydramnios (OR 2.66) and preterm labor (OR 1.67) compared to ICP alone. Further subgroup analysis based on the severity of ICP showed that elevated total bile acid concentrations were closely associated with an increased risk of preterm labour, meconium-stained amniotic fluid, and low birth weight in both ICP alone and ICP with GDM groups. ICP with GDM further worsened these outcomes, especially in women with severe ICP. The nomogram prediction model effectively predicted the occurrence of preterm labour in the ICP population. Conclusions: ICP with GDM may result in more adverse pregnancy outcomes, which are associated with bile acid concentrations. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate perinatal outcome in singleton pregnancies at term with isolated oligohydramnios, diagnosed by using the single deepest pocket method. Patients and Methods: In this historic cohort study, the perinatal outcomes of 196 women with isolated oligohydramnios at term, diagnosed by using the single deepest pocket method, were compared to 8,676 women with normal amniotic fluid volume. The primary outcome measure was the Cesarean section rate. Further outcome parameters included the rate of induction of labor, abnormal cardiotocography, umbilical cord pH and base excess, Apgar, meconium-stained liquor and admission to neonatal intensive care unit. Results: In the group with isolated oligohydramnios, there were significantly more Cesarean sections (p=0.0081) and more abnormal cardiotocographies (p=0.0005). Univariate and multivariate analyses showed that this difference was seen particularly in nulliparous women (p=0.0025 for Cesarean section and 0.0368 for abnormal cardiotocography). Peripartal and perinatal outcome parameters were not different between the two groups. Conclusion: In women with isolated oligohydramnios at term, there is no impact on fetal outcome. The influence of isolated oligohydramnios on the rate of cesarean section and abnormal cardiotocography is considered to be less than that of parity. [ABSTRACT FROM AUTHOR]

Intrahepatic cholestasis of pregnancy (ICP) is a hepatic disorder in pregnancy linked with adverse fetal outcomes, which primarily manifests in the late second and third trimesters of pregnancy. This review aims to recapitulate the existing evidence on factors that can predict detrimental perinatal outcomes in pregnant women diagnosed with intrahepatic cholestasis of pregnancy. We searched PubMed, Web of Science, Cochrane Library, Scopus, Medline, and Embase databases and selected studies related to predictors of fetal outcome in intrahepatic cholestasis of pregnancy. Studies of the articles showed that predictors of an adverse fetal outcome include in vitro fertilization (IVF) pregnancy, multifetal pregnancy, biochemical markers, gestational age of ICP onset, presence of comorbidities (preeclampsia and gestational diabetes mellitus), maternal history of ICP, and hepatobiliary disease. Intrahepatic cholestasis of pregnancy (ICP) complicates the pregnancy. Hence, early assessment of low-risk and high-risk groups will help to administer definite management protocols and strategies to prevent adverse neonatal outcomes. Further research should concentrate on the number of conditions/factors and the predictive power of different factors to determine the most reliable predictors and biomarkers that can predict adverse fetal outcomes and improve the assessment of risk in pregnancy complicated with ICP. [ABSTRACT FROM AUTHOR]

Background: Infertility affects about 80 million individuals worldwide and 10–15% of couples at reproductive age will seek medical assistance. There is increasing evidence that pregnancies after Assisted Reproduction Techniques (ART) are associated with pre-term birth, low birthweight, congenital defects, and increased mortality rates. The aim of this review is to assess all the published literature and provide an updated review on the effect of assisted conception and perinatal and neonatal outcomes. Methods: Comprehensive research on Pubmed/Medline, Scopus, and Google scholar electronic databases was conducted from July 2023 up to September 2023, using the terms assisted reproductive techniques, ART, in vitro fertilization, IVF, intracytoplasmic sperm injection, ICSI, preterm birth, PTB, low birth weight, LBW, chromosomal defects, congenital defects, and hypospadias. In total, 87 full text articles were retrieved and after a careful evaluation, 31 studies were selected for data extraction. Results: Our review demonstrated a higher risk of congenital and chromosomal defects, and a higher incidence of male genital tract defects and heart defects in ART pregnancies. Regarding pre-term birth, our results were contradictory. Conclusions: Although assisted reproduction techniques are associated with increased risks, they are safe regarding perinatal outcomes and couples should not be discouraged from utilizing them. Our results aim to alert clinicians to these specific outcomes and offer more personalized care and counseling to infertile couples and their children. [ABSTRACT FROM AUTHOR]

Introduction: Hypertensive disorders are the most common medical disorders encountered in pregnancy approximately 7% to 10% of all pregnancies. Hypertensive disorders are associated with foetal growth restriction, perinatal asphyxia, Iatrogenic prematurity, still births, preterm delivery, perinatal death, neonatal mortality and affects vital maternal organ system such as hepatic, renal, cardiorespiratory, cerebral and haematologic leading to maternal morbidity and mortality. The aim of the study was to assess the prevalence of severe pre-eclampsia, eclampsia and HELLP syndrome in our Hospital and its maternal and foetal outcome. Materials and Methods: This is retrospective study done in Department of Obstetrics and Gynaecology, Government General Hospital, Guntur over a period of six months (July 2023 to December 2023). All women presenting with severe pre-eclampsia, pre-eclampsia with imminent features, eclampsia and HELLP syndrome attending Labour room, Government General hospital Guntur were included in this study. Women with gestational HTN, nonsevere pre-eclampsia, chronic HTN were excluded. Ethical approval was obtained from institutional ethical committee. Out of all the total deliveries, 130 were studied. All detailed data such as demographic data, maternal age, parity, mode of delivery, obstetrical history, obstetric outcome, maternal complications, and foetal outcome were recorded. Results: 130 cases were recorded out of 3007deliveries. Among these, 66 cases were severe pre-eclampsia (50.76%),33 cases were imminent eclampsia(25.38%), 27 cases were Eclampsia(20.76%), four cases were HELLP syndrome(3%). The total prevalence was4.32% in our study. Majority of them were primigravida(61.53%) and belong to an age group of 20 to 25 (60%). Majority of them were delivered by caesarean section (67.69%). Most complications were seen in the eclampsia group. Prematurity was seen in 60.75% and LBW seen in 40.57%. 10 cases were IUD and 15 were neonatal deaths. Conclusion: It is one of the important causes of maternal and perinatal morbidity and mortality probably resulting from inadequate and suboptimal antenatal care and lack of education and awareness amongst people belonging to low socio-economic status. The high prevalence of hypertensive disorders complicates the maternal and foetal outcome. Antenatal surveillance, early detection, prompt treatment and early intervention and timely termination of pregnancy could reduce the maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Fetal inguinal hernia (FIH) is a rare event and only few cases were published in the medical literature. In the present study, we aimed to characterize the sonographic features, clinical presentation, management, outcomes, and differential diagnoses of FIH. Accordingly, we reviewed all 17 cases of FIH published in the medical literature, including one new case evaluated by our group. All 17 cases (100%) were male, and FIH is presented as a scrotal mass with a mean diameter of 38 ± 9.5 mm. The right side was dominant (62%). Peristalsis was reported in 80% of the cases, and blood flow was reported in two-thirds. Most cases were diagnosed in the third trimester (88%) at a mean gestational age (GA) of 33.1 ± 5.2 weeks. 60% of the cases had isolated FIH, and 40% had another sonographic or genetic abnormality. Three cases (18%) were syndromic with multiple malformations: trisomy 18, skeletal anomalies due to Jarcho-Levin syndrome, and undefined multiple joint contractures. Two cases (12%) had copathologies in the gastrointestinal tract: one had an echogenic bowel due to homozygosity for cystic fibrosis, and the other had low anorectal malformation. Bowel loop dilatation was observed prenatally in both cases and in another one isolated case (18%). GA at delivery was 38 ± 1.8 weeks, and the median time between diagnosis and delivery was 3 weeks. All three cases of neonatal death occurred in syndromic fetuses. All patients with nonsyndromic inguinal hernias underwent definitive surgical repair at a median of 13 days postpartum. No signs of strangulation and only one case of edematous bowel without necrosis have been reported. In conclusion, FIH should be suspected in male fetuses when an intrascrotal mass with peristalsis is diagnosed during the third trimester. Close follow-up until term in the absence of signs of bowel obstruction is reasonable, and in isolated FIH, the prognosis is favorable. [ABSTRACT FROM AUTHOR]

Background/Aim: Due to still controversial discussion regarding appropriate termination of low-risk singleton pregnancies beyond term, this retrospective study aimed to evaluate maternal and perinatal outcomes depending on gestational age and obstetric management. Patients and Methods: This is a retrospective cohort analysis including 3.242 low-risk singleton deliveries at the Department of Obstetrics of the University Hospital of Cologne between 2017 and 2022. According to current national guidelines, the cohort was subdivided into three gestational groups, group 1: 40+0- 40+6 weeks, group 2: 40+7-40+10 weeks and group 3>40+10 weeks. Results: In our cohort, advanced gestational age was associated with higher rates of secondary caesarean sections, lower rates of spontaneous vaginal deliveries, higher rates of meconium-stained amniotic fluid and depressed neonates with APGAR < 7 after 5 min. Analyzing obstetric management, induction of labor significantly increased the rate of secondary sections and reduced the rate of spontaneous deliveries, while the percentage of assistant vaginal deliveries was independent from obstetric management and gestational age. Induction of labor also significantly enhanced the need for tocolytic subpartu and epidural anesthesia and caused higher rates of abnormalities in cardiotocography (CTG), which also resulted in more frequent fetal scalp blood testing; however, the rate of fetal acidosis was independent of both obstetric management and gestational age. Conclusion: Our study supports expectant management of low-risk pregnancies beyond term, as induction of labor increased the rate of secondary sections and did not improve perinatal outcome. [ABSTRACT FROM AUTHOR]

Background: The patients who are of age 35 or more at the time of delivery are termed as elderly gravida patients. The topic is related to concern as in previous 2-3 decades there is a shift towards advanced maternal age due to multiple reasons and it can result in adverse maternal as well as perinatal outcomes. Also reduced fertility with increasing maternal age is evidenced by decline in ovarian reserve and quality. Materials & Methods: An observational retrospective study participated by 500 pregnant women. These 500 patients are divided into a group of cases consisting of 250 elderly gravida patients who are compared with 250 patients of control group of non-elderly gravida group. Results: A significant difference can be noticed in associated morbidities and mortalities in maternal as well as perinatal context with increasing maternal age. Along with elderly gravida patients are at higher risk of undergoing operative delivery as well. Conclusions: The elderly gravida patients should be considered in high risk group due to possibility of antecedent complications and should be counseled and managed accordingly. For this purpose preconceptional counseling, prenatal diagnosis along with management of labor can play a vital role. [ABSTRACT FROM AUTHOR]

Objective: To describe the perinatal outcome of fetuses predicted to be large‐for‐gestational age (LGA) on universal third‐trimester ultrasound in non‐diabetic pregnancies of women attempting vaginal delivery. Methods: This was a prospective population‐based cohort study of patients from a single tertiary maternity unit in the UK offering universal third‐trimester ultrasound and practicing expectant management of suspected LGA until 41–42 weeks. All women with a singleton pregnancy and an estimated due date between January 2014 and September 2019 were included. Women delivering before 37 weeks, those having a planned Cesarean delivery, those with pre‐existing or gestational diabetes, those with fetal abnormalities and those who did not undergo a third‐trimester scan were excluded from the assessment of perinatal outcome of cases with LGA predicted on ultrasound after implementation of the universal scan period. Association of LGA on universal third‐trimester ultrasound screening and perinatal adverse outcome was assessed, with the exposures of interest being estimated fetal weight (EFW) at the 90th–95th, > 95th and > 99th percentile. The reference group was composed of fetuses with EFW at the 30th–70th percentile. Analysis was performed using multivariate logistic regression. The evaluated adverse perinatal outcomes included a composite outcome of admission to neonatal intensive care unit, Apgar score < 7 at 5 min and arterial cord pH < 7.1 (CAO1) and a composite outcome of stillbirth, neonatal death and hypoxic ischemic encephalopathy (CAO2). Secondary maternal outcomes were induction of labor, mode of delivery, postpartum hemorrhage, shoulder dystocia and obstetric anal sphincter injury. Results: Cases with EFW > 95th percentile on universal third‐trimester scan were at increased risk of CAO1 (adjusted odds ratio (aOR), 2.18 (95% CI, 1.69–2.80)) and CAO2 (aOR, 2.58 (95% CI, 1.05–6.34)). Cases with EFW at the 90th–95th percentile had a less pronounced increase in the risk of CAO1 (aOR, 1.35 (95% CI, 1.02–1.78)) and were not at increased risk of CAO2. All pregnancies with a fetus predicted to be LGA were at increased risk of all of the evaluated secondary maternal outcomes except for obstetric anal sphincter injury. The risk of adverse maternal outcome was typically higher with increasing EFW. Post‐hoc exploration of data suggested that shoulder dystocia had a limited contribution to composite adverse perinatal outcomes in LGA cases (population attributable fraction of 10.8% for CAO1 and 29.1% for CAO2). Conclusions: Cases with EFW > 95th percentile are at increased risk of severe adverse perinatal outcome, such as death and hypoxic ischemic encephalopathy. These findings should aid antenatal counseling regarding the associated risk and delivery options. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancy is a serious issue in both developed and underdeveloped nations. Causative factors being early puberty, early marriage, sociocultural factors, illiteracy, early sexual activity, lack of knowledge and access to contraception, ignorance, and poverty. Teenage pregnancy has been associated with several adverse consequences, including anaemia, preeclampsia, premature delivery, infants being small for gestational age, low birth weight, and increased neonatal morbidity and mortality. Materials and Methods: A comparative study regarding maternal and perinatal outcome was conducted between 100 cases of primigravidae aged 14- 19-year-old and 100 cases of primigravidae of 20-29-year-old attending Government Maternity Hospital, Tirupati and willing to give written informed consent. All high risk pregnancies were excluded from the study. Results: The mean age in teen age primigravidae found to be 18.1yrs where as it is 24.6yrs in adult primigravidae. There is no significant difference in distribution of unbooked cases in teenage and adult pregnancies. 19% of teenage pregnant women were illiterate compared to only 4% in adult group. 69% of teenage group and 52% of adult group belongs to low socioeconomic status. Majority of study participants are of term gestational age. Teenage pregnancy is an important risk factor for development of anaemia and hypertension incidence being 68% & 27% compared to that of adult group where incidence being 32% & 8% respectively. Preterm and IUGR is a common neonatal outcome observed in teenage pregnancies compared to that of adult pregnancies. 2 IUDs observed in teenage group and no IUDs in adult group. Incidence of failed induction and cephalopelvic disproportion were significantly more associated with teenage primigravidae. Majority of the adult primigravidae adopted for one or other method of contraception. Conclusion: Teenage mothers had numerous complications in pregnancy, anemia, pre-eclampsia, and preterm labor, oligo hydamnios, Thyroid disorders. Higher operational intervention and a higher LSCS rate are also contributing factors in the rise in maternal morbidity. Neonatal morbidity is also more in teenage mothers due to prematurity, low birth weight, and perinatal asphyxia. Stringent rules should be implemented to avoid early marriages and teenage pregnancies. [ABSTRACT FROM AUTHOR]

The objective of this study is to determine the perinatal outcome in pregnancies with hydropic fetuses. The study was a retrospective evaluation of data on intrauterine transfusion (IUT) done in hydropic fetuses for correction of severe anemia from December 2017 to August 2021 in AIIMS Jodhpur. The retrospective case series involves five cases that underwent IUT for severe fetal anemia. All had a sign of hydrops at the time of presentation. Out of five cases, four were of alloimmunized pregnancies while one was of hydrops fetalis secondary to parvovirus infection. The presence of severe hydrops at the time of presentation is a poor prognostic factor affecting fetal survival post-IUT therapy. [ABSTRACT FROM AUTHOR]

Background and Objectives: ABO and Rh blood types are known to have associations with health and disease, but studies on their relationship to pregnancy outcomes have been largely inconclusive. We aimed to examine the associations between ABO and Rh blood groups in pregnant women with maternal-neonatal characteristics and outcomes including hypertensive disorders of pregnancy, gestational diabetes, cesarean section rate, preterm birth, postpartum quantitative blood loss, birth weight, and appearance, pulse, grimace, activity, and respiration scores. Methods: At the time of delivery, 2497 consecutive patients were tested for ABO and Rh blood groups. Only those who delivered singleton infants were included in the analysis (2392 patients, 95.8%). Demographic and clinical data were obtained from the electronic medical record. Associations between blood groups and maternal-neonatal characteristics and outcomes were assessed using logistic regression models. A significance threshold of 0.05 was used for all comparisons. Results: Of the 2392 delivering patients, 46.9% were blood group O, 37.5% were blood group A, 12.2% were blood group B, and 3.4% were blood group AB. In addition, 85.9% were Rh-positive and 14.1% Rh-negative. A total of 2127 (88.9%) women delivered at term. The cesarean section rate was 32.4%, 183 (7.7%) had chronic hypertension, 275 (11.5%) had gestational diabetes, and 396 (16.6%) had a postpartum hemorrhage. The median birth weight was 3330 g (interquartile range 2940-3640). No blood groups were significantly associated with these characteristic and outcome measures. Conclusion: At the time of delivery, no significant associations were identified between ABO and Rh blood groups and maternal-neonatal characteristics and outcomes in this delivery cohort of over 2000 women. [ABSTRACT FROM AUTHOR]

Background: Meconium is the first substance secreted from fetal intestines and consist of intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile and water. Its formation begins around 10-12 weeks of gestation and the quantity goes on increasing as the gestational age advances and it is the post-mature baby who is at a greater risk of passage of meconium in utero and its consequences like meconium aspiration syndrome (MAS). Aim & Objective: 1 Study of maternal risk factors and compare the perinatal outcome in thick and thin meconium stained amniotic fluid.2 study the mode of delivery in a labour complicated by meconium stained amniotic fluid. Methods: Study design: Prospective Study. Study setting: Department of Obstetrics and Gynaecology, Rohilkhand medical college and hospital Bareilly Study duration: From November 2022 to November 2023. Study population: All meconium stained amniotic fluid patients admitted in our institute during study period included in the study. Sample size: 50 Results: Majority of cases found in 31-35 years age group 20 cases (40%) followed by above 35 years age group 14 cases (28%), 13 (26%) cases in 26-30 years age group and 4 cases in 18-25 years age group. most of cases found with thin MSAF 24 (48%) followed by moderate thick MSAF 14 (28%) and thick MSAF found in 12 cases (24%). majority of cases presented with post maturity 30 (60%) followed by prolonged labour 31, Anemia 25 cases, IUGR 17,PIH 14 and 8 cases found with oligohydramnios. Most common mode of delivery was LSCS 22 cases followed by AD 18 cases and Normal vaginal delivery observed in 10 cases. majority of cases found Asphyxia 60% followed by meconium aspiration syndrome 12 cases, neonatal pneumonia 8, Early/late onset sepsis 5, persistent pulmonary hypertension found in 4 cases. Mortality 2%. Conclusion: Most common maternal risk factor was post maturity, Majority of cases delivered through LSCS, Perinatal Mortality was 2%. [ABSTRACT FROM AUTHOR]

Background: Meconium aspiration syndrome is one of the dreadful complications of prolonged labor, fetal hypoxia due to any cause and prematurity. Once the meconium is aspirated by fetus it may cause severe meconium pneumonitis, respiratory distress, acidosis and ultimately respiratory failure. Extensive neonatal care, surfactant therapy and ventilatory management is required for babies developing respiratory distress secondary to meconium aspiration and despite extensive medical care MAS may prove fatal in many cases. Aim & Objective: 1 Clinical study of maternal risk factors and the perinatal outcome in meconium stained amniotic fluid.2. To study the mode of delivery in a labour complicated by meconium stained amniotic fluid. Methods: Study design: Prospective Study. Study setting: Department of Obstetrics and Gynaecology, National institute of medical science and research, Jaipur, Rajasthan. Study duration: From October 2022 to October 2023. Study population: All meconium stained amniotic fluid patients admitted in our institute during study period included in the study. Sample size: 100 Results: majority of study participants were from 31-35 years age group e.g. 40 followed by 26-30,21-25,18-20 and >35 found 28,19,9 and 4 respectively. Most of the study subjects were Primipara contributing 60 (60%) and 40 (40%) were Multipara. majority of study participants were from > 40 weeks of gestational age contributing 60 (60%) followed by 37-40 weeks 30 (30%) and < 37 weeks 10 (10%) respectively. majority of cases found with moderate thick MSAF 57 (57%) followed by thin MSAF 27 (27%) and thick MSAF found in 21 cases (21%). majority of cases presented with post maturity 60 (60%) followed by PIH 37 (37%), prolonged labour 33 (33%), Anemia 29 (29%), Multiple risk factors 25 (25%), IUGR 17 (17%) and 10 cases found with Oligohydrmnios 10 (10%). majority of cases delivered through LSCS 55 followed by AD 27 and NVD 18. majority of cases with normal birth weight 80 (80%) 20 cases with low birth weight. majority of cases discharged 91 followed by 7 cases DAMA and 2 cases death during treatment. Conclusion: Majority of the cases were Primipara, Most common maternal risk factor was post maturity, Maximum of cases delivered through LSCS, Perinatal Mortality was 2%. [ABSTRACT FROM AUTHOR]

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STUDY QUESTION Is embryo culture in a closed time-lapse system associated with any differences in perinatal and maternal outcomes in comparison to conventional culture and spontaneous conception? SUMMARY ANSWER There were no significant differences between time-lapse and conventional embryo culture in preterm birth (PTB, <37 weeks), low birth weight (LBW, >2500 g) and hypertensive disorders of pregnancy for singleton deliveries, the primary outcomes of this study. WHAT IS KNOWN ALREADY Evidence from prospective trials evaluating the safety of time-lapse incubation for clinical use show similar embryo development rates, implantation rates, and ongoing pregnancy and live birth rates when compared to conventional incubation. Few studies have investigated if uninterrupted culture can alter risks of adverse perinatal outcomes presently associated with IVF when compared to conventional culture and spontaneous conceptions. STUDY DESIGN, SIZE, DURATION This study is a Swedish population-based retrospective registry study, including 7379 singleton deliveries after fresh embryo transfer between 2013 and 2018 from selected IVF clinics. Perinatal outcomes of singletons born from time-lapse-cultured embryos were compared to singletons from embryos cultured in conventional incubators and 71 300 singletons from spontaneous conceptions. Main perinatal outcomes included PTB and LBW. Main maternal outcomes included hypertensive disorders of pregnancy (pregnancy hypertension and preeclampsia). PARTICIPANTS/MATERIALS, SETTING, METHODS From nine IVF clinics, 2683 singletons born after fresh embryo transfer in a time-lapse system were compared to 4696 singletons born after culture in a conventional incubator and 71 300 singletons born after spontaneous conception matched for year of birth, parity, and maternal age. Patient and treatment characteristics from IVF deliveries were cross-linked with the Swedish Medical Birth Register, Register of Birth Defects, National Patient Register and Statistics Sweden. Children born after sperm and oocyte donation cycles and after Preimplantation Genetic testing cycles were excluded. Odds ratio (OR) and adjusted OR were calculated, adjusting for relevant confounders. MAIN RESULTS AND THE ROLE OF CHANCE In the adjusted analyses, no significant differences were found for risk of PTB (adjusted OR 1.11, 95% CI 0.87–1.41) and LBW (adjusted OR 0.86, 95% CI 0.66–1.14) or hypertensive disorders of pregnancy; preeclampsia and hypertension (adjusted OR 0.99, 95% CI 0.67–1.45 and adjusted OR 0.98, 95% CI 0.62–1.53, respectively) between time-lapse and conventional incubation systems. A significantly increased risk of PTB (adjusted OR 1.31, 95% CI 1.08–1.60) and LBW (adjusted OR 1.36, 95% CI 1.08–1.72) was found for singletons born after time-lapse incubation compared to singletons born after spontaneous conceptions. In addition, a lower risk for pregnancy hypertension (adjusted OR 0.72 95% CI 0.53–0.99) but no significant difference for preeclampsia (adjusted OR 0.87, 95% CI 0.68–1.12) was found compared to spontaneous conceptions. Subgroup analyses showed that some risks were related to the day of embryo transfer, with more adverse outcomes after blastocyst transfer in comparison to cleavage stage transfer. LIMITATIONS, REASONS FOR CAUTION This study is retrospective in design and different clinical strategies may have been used to select specific patient groups for time-lapse versus conventional incubation. The number of patients is limited and larger datasets are required to obtain more precise estimates and adjust for possible effect of additional embryo culture variables. WIDER IMPLICATIONS OF THE FINDINGS Embryo culture in time-lapse systems is not associated with major differences in perinatal and maternal outcomes, compared to conventional embryo culture, suggesting that this technology is an acceptable alternative for embryo incubation. STUDY FUNDING/COMPETING INTEREST(S) The study was financed by a research grant from Gedeon Richter. There are no conflicts of interest for all authors to declare. TRIAL REGISTRATION NUMBER N/A [ABSTRACT FROM AUTHOR]

STUDY QUESTION Does the transfer of single low-grade blastocysts result in acceptable reproductive and perinatal outcomes compared to the transfer of single good-grade blastocysts? SUMMARY ANSWER The transfer of single low-grade blastocysts resulted in a reduced live birth rate of around 30% (14% for very low-grade blastocysts) compared to 44% for single good-grade blastocysts, but does not lead to more adverse perinatal outcomes. WHAT IS KNOWN ALREADY It is known that low-grade blastocysts can result in live births. However, the current studies are limited by relatively small sample sizes and single-centre designs. Furthermore, evidence on perinatal outcomes after transferring low-grade blastocysts is limited. STUDY DESIGN, SIZE, DURATION We conducted a multi-centre, multi-national retrospective cohort study of 10 018 women undergoing 10 964 single blastocyst transfer cycles between 2009 and 2020 from 14 clinics across Australia, China, and New Zealand. PARTICIPANTS/MATERIALS, SETTING, METHODS Blastocysts were graded individually based on assessment of the morphology and development of the inner cell mass (ICM) and trophectoderm (TE), and were grouped into three quality categories: good- (AB, AB, or BA), moderate- (BB), and low-grade (grade C for ICM or TE) blastocysts. CC blastocysts were individually grouped as very low-grade blastocysts. Logistic regression with generalized estimating equation was used to analyse the association between blastocyst quality and live birth as well as other reproductive outcomes. Binomial, multinomial logistic, or linear regression was used to investigate the association between blastocyst quality and perinatal outcomes. Odds ratio (OR), adjusted OR (aOR), adjusted regression coefficient, and their 95% CIs are presented. Statistical significance was set at P  <   0.05. MAIN RESULTS AND THE ROLE OF CHANCE There were 4386 good-grade blastocysts, 3735 moderate-grade blastocysts, and 2843 low-grade blastocysts were included in the analysis, for which the live birth rates were 44.4%, 38.6%, and 30.2%, respectively. Compared to good-grade blastocysts, the live birth rate of low-grade blastocysts was significantly lower (aOR of 0.48 (0.41–0.55)). Very low-grade blastocysts were associated with an even lower live birth rate (aOR 0.30 (0.18–0.52)) and their absolute live birth rate was 13.7%. There were 4132 singleton live births included in the analysis of perinatal outcomes. Compared with good-grade blastocysts, low-grade blastocysts had comparable preterm birth rates (<37 weeks, aOR 1.00 (0.65–1.54)), birthweight Z-scores (adjusted regression coefficient 0.02 (0.09–0.14)), and rates of very low birth weight (<1500 g, aOR 0.84 (0.22–3.25)), low birth weight (1500–2500 g, aOR 0.96 (0.56–1.65)), high birth weight (>4500 g, aOR 0.93 (0.37–2.32)), small for gestational age (aOR 1.63 (0.91–2.93)), and large for gestational age (aOR 1.28 (0.97–1.70)). LIMITATIONS, REASONS FOR CAUTION Due to the nature of the retrospective design, residual confounding could not be excluded. In addition, the number of events for some perinatal outcomes was small. Between-operator and between-laboratory variations in blastocyst assessment were difficult to control. WIDER IMPLICATIONS OF THE FINDINGS Patients undergoing IVF should be informed that low-grade blastocysts result in a lower live birth rate, however they do not increase the risk of adverse perinatal outcomes. Further research should focus on the criteria for embryos that should not be transferred and on the follow-up of long-term outcomes of offspring. STUDY FUNDING/COMPETING INTEREST(S) H.Z. is supported by a Monash Research Scholarship. B.W.J.M. is supported by a NHMRC Investigator grant (GNT1176437). R.W. is supported by an NHMRC Emerging Leadership Investigator grant (2009767). B.W.J.M. reports consultancy, travel support, and research funding from Merck. The other authors do not have competing interests to disclose. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]