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Objectives: There have been significant advances in the medical management of severe postpartum hemorrhage (sPPH) over recent decades, which is reflected in numerous published guidelines. To date, many of the currently available national and international guidelines recommend recombinant factor VIIa (rFVIIa) to be used only at a very late stage in the course of sPPH, as a "last resort", before or after hysterectomy. Based on new safety data, rFVIIa has recently been approved by the European Medicines Agency (EMA) and Swissmedic for use in sPPH, if uterotonics are insufficient to achieve hemostasis, which in fact is significantly earlier in the course of postpartum hemorrhage (PPH). We therefore aimed to develop expert consensus guidance as a step toward standardizing care with the use of rFVIIa for clinicians managing women experiencing life-threatening sPPH. Methods: The consensus process consisted of one face-to-face meeting with a group of nine experts, including eight obstetrician-gynecologists and a hematologist highly experienced in sPPH care in tertiary care perinatal centers. The panel was representative of multidisciplinary expertise in the European obstetrics community and provided consensus opinion in answer to pre-defined questions around clinical practice with rFVIIa in the management of sPPH. Recommendations have been based on current national and international guidelines, extensive clinical experience, and consensus opinion, as well as the availability of efficacy and new safety data. Results: The expert panel developed 17 consensus statements in response to the 13 pre-defined questions on the use of rFVIIa in the management of sPPH including: available efficacy and safety data and the need for interdisciplinary expertise between obstetricians, anesthesiologists, and hematologists in the management of sPPH. Based on novel data, the experts recommend: (1) earlier administration of rFVIIa in patients with sPPH who do not respond to uterotonic administration to optimize the efficacy of rFVIIa; (2) the importance of hematological parameter prerequisites prior to the administration of rFVIIa to maximize efficacy; and (3) continued evaluation or initiation of further invasive procedures according to standard practice. Furthermore, recommendations on the timing of rFVIIa treatment within the sPPH management algorithm are outlined in a range of specified clinical scenarios and settings, including vaginal delivery, cesarean section, and smaller birthing units before transfer to a tertiary care center. The panel agreed that according to available, and new data, as well as real-world experience, there is no evidence that the use of rFVIIa in patients with sPPH increases the risk of thromboembolism. The authors acknowledge that there is still limited clinical effectiveness data, as well as pharmacoeconomic data, on the use of rFVIIa in sPPH, and recommend further clinical trials and efficacy investigation. Conclusions: This expert panel provides consensus guidance based on recently available data, clinical experience, and expert opinion, augmented by the recent approval of rFVIIa for use in sPPH by the EMA. These consensus statements are intended to support clinical care for sPPH and may help to provide the impetus and a starting point for updates to existing clinical practice guidelines. [ABSTRACT FROM AUTHOR]

To our knowledge, there are limited data to suggest that there is an association between prophylactic use of low-dose aspirin and increased risk of progression of SARS-CoV-2 infection. In our opinion, during the COVID-19 pandemic, it is still essential to provide first-trimester screening for placental complications and to prescribe low-dose aspirin in women who are identified as high risk for pre-eclampsia and fetal growth restriction. [Extracted from the article]

The article offers guidelines from the European Association of Perinatal Medicine for preterm labor and birth management. Topics discussed include the etiology of spontaneous preterm delivery (PTD), a study suggesting that placenta is not sterile, and the studies that published the risk factors for spontaneous PTD.

Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing. [ABSTRACT FROM AUTHOR]

Aim: Retrospective analysis of the course of pregnancy, labor and mode of anesthesia in women with portal hypertension and esophageal varices induced by portal vein thrombosis. Material: From 2000 to 2012 seven pregnant were admitted. None had liver transplantation (Ltx), the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed. Results: Pregnancy in five cases proceeded physiologically. In one threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolytic. One required variceal banding twice. In three thrombocytopenia worsened, with platelet count < 70 g/L (up to 59 g/L). They received platelet transfusion before delivery. In one case, significant hipoproteinemia (4.7 g/L) occurred. In a case, GDM G1 and oligohydramnios were found. All women delivered at term (37-40 Hbd). In all general anesthesia with the use of remifentanil was done. There were no fluctuations in MAP and HR. Incision to delivery time was 2.5 min. Time from opioid administration to birth was <4 min. All children were born in good condition, weight 10-90 percentile. Regional anesthesia is contraindicated in patients with thrombocytopenia. In patients with esophageal varices sudden increase in heart rate and blood pressure can cause hemorrhage. Conclusion: Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the non-invasive prenatal testing (NIPT) for pregnant women who want to detect trisomy 21 in their unborn child. It states that NIPT improve the quality of prenatal testing for fetal abnormalities. It further discusses aneuploidy screening, chromosomal microarray analysis and testing in pregnancy.

The Colton (Coa) antigen is of high frequency; its incidence in Caucasians is about 99.8%. Reports on haemolytic transfusion reactions and haemolytic disease of the foetus/newborn (HDFN) due to anti-Coa are rare. We report a severe HDFN due to anti-Coa. The first child of the mother was healthy. The second died a few hours after delivery because of hydrops fetalis, likely due to HDFN; anti-Coa in the maternal serum, the father typed as Co(a+). The third pregnancy was followed up by the measurements of anti-Coa titre (additional antibodies were excluded), its functional activity by the chemiluminescence test (CLT) and the Doppler flow in the middle cerebral artery of the foetus. Increased values of antibody titre up to 128, the CLT to 30% and multiplex of median of the peak systolic velocity to 1·71 indicated haemolytic disease and the necessity for an intrauterine transfusion. The foetus received the maternal red blood cells (RBCs). Delivery had to be by Caesarean section for obstetrical reasons at 34-week gestation. The newborn (anti-Coa on red cells and in plasma, the rise of the bilirubin concentration up to 333 μmol L−1) had four exchange transfusions: the first of maternal RBCs, the remaining of donor’s Co(a+) cells and one top-up transfusion. The baby was discharged in good health. Anti-Coa was responsible for severe HDFN. Proper monitoring during pregnancy and antenatal and post-natal therapy were successful. This is the second severe published HDFN due to anti-Coa. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old gravida suffering from Galen aneurysmal malformation. The patient underwent ultrasound scan which showed fetal hydrops, impaired contractility and cardiomegaly. She was also diagnosed with dural sinus malformation (DSM) in the fetus indicating edema.

The article presents a case study of a 35-year-old patient who was diagnosed with Galen aneurysmal malformation. Topics discussed include fetal dural sinus malformation (DSM) to be a rare congenital dilatation of the dural sinus pouch, ultrasound revealing fetal hydrops, morphologically normal heart with cardiomegaly and impaired contractility, and management of Mirror syndrome.

Over 50 different red blood cell antigens have been reported to be associated with hemolytic disease of the fetus and newborn (HDFN). Apart form anti-RhD, also anti-Rhc and anti-K1 (Kell group) are related to severe fetal disease. Maternal anti-K is the second most common alloantibody (following anti-D) and accounts for 10%-15% patients with antibody-mediated severe hemolytic anemia. A 34-year-old multipara was being monitored with ultrasonography scans during her fifth pregnancy starting from 15 weeks of gestation with a starting anty-K titer of 1:2058. She was being monitored earlier on in gestation due to her obstetrical history of anemia and multiple intrauterine blood transfusions in previous pregnancies. The first pregnancy was uneventful. The anti-K antibodies were detected in the 3rd trimester of her second gestation. At the time she gave birth to a healthy son who did not have HDFN. During her 3rd pregnancy the titer of her antibodies increased 2 fold to 1:512 and the patient had her first intrauterine transfusion at 22 weeks of gestation with a MCA PSV of 1.96 MoM. The hemoglobin level measured before the first transfusion was 2.4 g/dl. In total from 23+1 to 35+1 weeks of gestation 7 intrauterine blood transfusions were performed to the placental cord insertion site. The amount of blood transfused was calculated according to the gestational age and in total 332 ml of packed red blood cells (PRBC) was given. A c-section was performed at 37 weeks of gestation and a son of 3200 g was born requiring 1 blood transfusion after delivery. In the subsequent fourth pregnancy, the antibody titer increased form 1:512 to 1:2048. Nuchal edema, mild ascites and tricuspid regurgitation were observed at 20 weeks of gestation. The MCA PSV was 2.13 MoM. An intrauterine blood transfusion was done. The hemoglobin level of the fetus was 2,0 g/dl. From 20+0 to 30+5 weeks of gestation 6 intrauterine blood transfusions were performed through the placental cord insertion site giving in total 183 PRBC. At 31 weeks of gestation the patient had preterm delivery and gave birth naturally to a baby girl in good condition. During the fifth pregnancy the first titer obtained was 1:2048. At 17+6 weeks of gestation, the MCA PSV measured was 3.1 MoM and there was general edema of the fetus. She was admitted to hospital for an intrauterine blood transfusion. Due to the technical difficulties related to the early pregnancy and posterior placenta 10 ml of PRBC was given to the peritoneal cavity. Intrauterine demise was reported the following day. In anti-Kell alloimmunization the fetal anemia is mainly caused by the suppression of erythropoiesis, which is directly induced by anti-Kell antibodies expressed by the erythroid progenitor cells. The severity of anti-Kell alloimmunization is independent of the antibody titer - severe anemia has been reported with lower titers than in anti D alloimmunisation. In conclusion, the anti-Kell alloimmunization has an increasingly severe course in subsequent pregnancies. The severity of the disease can exceed the management possibilities of the intrauterine therapy. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Transvaginal cervical length measurement as a predictor of preterm delivery in IVF patients," by M. Wielgos and colleagues is presented.

A letter to the editor is presented concerning the medical prognosis of spontaneous preterm birth (PTB) using biophysical ultrasound anterior cervical angle (ACA).

A letter to the editor is presented in response to the article "Sonographic Estimation of Fetal Head Circumference: How Accurate Are We?" by N. Melamed and colleagues in the January 2011 issue

An abstract of the conference paper "Cervical bacterial colonization and cervical length in women with threatening preterm labor," by D. A. Bomba-Opon and colleagues is presented.

An abstract of the conference paper "Thrombocytopenia in neonates treated by repeated intrauterine transfusions," by R. Bartkowiak and colleagues, is presented.

An abstract of the conference paper "The evolution of indications for amniocentesis-four years experience after introduction of skrining programme," by P. Wegrzyn and colleagues is presented.

An abstract of the conference paper "Is mid-gestational cervical length measurement as sensitive prediction factor of preterm delivery in IVF as in spontaneous singleton pregnancies?," by I. Szymusik and colleagues is presented.

An abstract of the conference paper "NT-proBNP concentrations and MCA velocimetry in fetuses severely affected by feto-maternal isoimmunisation-preliminary report," by K. Luterek and colleagues is presented.

An abstract of the conference paper "Placental measurements in the first trimester and adiponectin, leptin and insulin plasma concentrations," by D. A. Bomba-Opon and colleagues is presented.

An abstract of the conference paper "Comparison of conventional and three-dimensional sonohysterography in the assessment of submucous uterine myomas before their hysteroscopic resection," by R. Bartkowiak and colleagues is presented.