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Objective: To explore the relationship between pregnancy complications and maternal near-miss (MNM). Methods: Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012–2022. The MNM ratio refers to the number of MNM per 1000 live births, and maternal mortality refers to the number of maternal deaths per 100,000 live births. Chi-square trend tests (χ2trend) were used to determine trends in proportions by year. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM. Results: Our study included 780,359 women with 731,185 live births, a total of 2461 MNMs, and 52 maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23–3.50), and the maternal mortality was 7.11 per 100,000 live births (95%CI: 5.18–9.04). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). From 2012 to 2022, the proportion of coagulation/hematological dysfunction among MNM increased from 49.14% in 2012 to 86.39% in 2022, which was the only cause of MNM that showed an increased trend (χ2trend = 7.43, P = 0.01). Results of multivariate logistic regression analysis showed that 10 pregnancy complications were risk factors for MNM: hemorrhage disorder (aOR = 21.50, 95%CI: 19.64–23.54), infections (aOR = 1.91, 95%CI: 1.64–2.22), hypertension (aOR = 4.50, 95%CI: 4.08–4.98), heart disease (aOR = 14.96, 95%CI: 11.51–19.44), embolic disease (aOR = 171.70, 95%CI: 94.08-313.36), liver disease (aOR = 1.54, 95%CI: 1.25–1.90), anaemia (aOR = 4.72, 95%CI: 4.29–5.19), renal disease (aOR = 5.44, 95%CI: 4.00-7.40), pulmonary disease (aOR = 14.85, 95%CI: 8.33–26.50), and connective tissue disease (aOR = 5.15, 95%CI: 3.06–8.66). Conclusion: The MNM ratio was relatively low in Hunan Province. Several pregnancy complications increased the risk of MNM. It is helpful for clinical counseling and public health policies, which may contribute to preventing MNM. [ABSTRACT FROM AUTHOR]

Background: African cattle represent a unique resource of genetic diversity in response to adaptation to numerous environmental challenges. Characterising the genetic landscape of indigenous African cattle and identifying genomic regions and genes of functional importance can contribute to targeted breeding and tackle the loss of genetic diversity. However, pinpointing the adaptive variant and determining underlying functional mechanisms of adaptation remains challenging. Results: In this study, we use selection signatures from whole-genome sequence data of eight indigenous African cattle breeds in combination with gene expression and quantitative trait loci (QTL) databases to characterise genomic targets of artificial selection and environmental adaptation and to identify the underlying functional candidate genes. In general, the trait-association analyses of selection signatures suggest the innate and adaptive immune system and production traits as important selection targets. For example, a large genomic region, with selection signatures identified for all breeds except N'Dama, was located on BTA27, including multiple defensin DEFB coding-genes. Out of 22 analysed tissues, genes under putative selection were significantly enriched for those overexpressed in adipose tissue, blood, lung, testis and uterus. Our results further suggest that cis-eQTL are themselves selection targets; for most tissues, we found a positive correlation between allele frequency differences and cis-eQTL effect size, suggesting that positive selection acts directly on regulatory variants. Conclusions: By combining selection signatures with information on gene expression and QTL, we were able to reveal compelling candidate selection targets that did not stand out from selection signature results alone (e.g. GIMAP8 for tick resistance and NDUFS3 for heat adaptation). Insights from this study will help to inform breeding and maintain diversity of locally adapted, and hence important, breeds. [ABSTRACT FROM AUTHOR]

Background: Maternal near-miss (MNM) is defined by the World Health Organization (WHO) working group as a woman who nearly died but survived a life-threatening condition during pregnancy, childbirth, or within 42 days of termination of pregnancy due to getting quality of care or by chance. Despite the importance of the near-miss concept in enhancing quality of care and maternal health, evidence regarding the prevalence of MNM, its primary causes and its determinants in Africa is sparse; hence, this study aimed to address these gaps. Methods: A systematic review and meta-analysis of studies published up to October 31, 2023, was conducted. Electronic databases (PubMed/Medline, Scopus, Web of Science, and Directory of Open Access Journals), Google, and Google Scholar were used to search for relevant studies. Studies from any African country that reported the magnitude and/or determinants of MNM using WHO criteria were included. The data were extracted using a Microsoft Excel 2013 spreadsheet and analysed by STATA version 16. Pooled estimates were performed using a random-effects model with the DerSimonian Laired method. The I2 test was used to analyze the heterogeneity of the included studies. Results: Sixty-five studies with 968,555 participants were included. The weighted pooled prevalence of MNM in Africa was 73.64/1000 live births (95% CI: 69.17, 78.11). A high prevalence was found in the Eastern and Western African regions: 114.81/1000 live births (95% CI: 104.94, 123.59) and 78.34/1000 live births (95% CI: 67.23, 89.46), respectively. Severe postpartum hemorrhage and severe hypertension were the leading causes of MNM, accounting for 36.15% (95% CI: 31.32, 40.99) and 27.2% (95% CI: 23.95, 31.09), respectively. Being a rural resident, having a low monthly income, long distance to a health facility, not attending formal education, not receiving ANC, experiencing delays in health service, having a previous history of caesarean section, and having pre-existing medical conditions were found to increase the risk of MNM. Conclusion: The pooled prevalence of MNM was high in Africa, especially in the eastern and western regions. There were significant variations in the prevalence of MNM across regions and study periods. Strengthening universal access to education and maternal health services, working together to tackle all three delays through community education and awareness campaigns, improving access to transportation and road infrastructure, and improving the quality of care provided at service delivery points are key to reducing MNM, ultimately improving and ensuring maternal health equity. [ABSTRACT FROM AUTHOR]

Objective was to compare the maternal mortality before and after the pandemic.Patients and Methods: Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software.Results: There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: − 24.0− 33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9− 23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53− 6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.Conclusion: Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors of cesarean delivery in pregnant women with diabetes mellitus and complications caused by gestational diabetes. Materials and Methods: A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Phatthalung Hospital. The participants consisted of pregnant women who labored at Phatthalung Hospital between 2017 and 2021. The inclusion criteria comprised women who labored from 28 to 42 weeks and had complete medical records. Patients having previous cesarean sections, cesarean section on maternal demand, and twin pregnancy were excluded. The study group was diabetic mellitus pregnant women, while non-diabetic pregnant women was generated by random numbers at ratio of 1:1 as control group. The data collected were demographic data, age, body mass index (BMI), number of gestations, parity, abortion, type of diabetic mellitus, underlying disease, route of delivery, indications for cesarean delivery, and maternal and neonatal outcomes. Results: Two thousand twelve pregnant women consisted of 1,006 pregnancies with diabetes and 1,006 non-diabetic pregnancies. Pregnant women with diabetes significantly increased the risk of cesarean section 1.42 time (95% CI 1.19 to 1.70, p<0.001). The greatest indication for cesarean section of both groups was cephalopelvic disproportion, but failure for induction of labor and macrosomia were found in the study group more than in the control group. Logistic regression analysis, adjusted for age group, number of gestations, and BMI, showed that pregnancy-induced hypertension and newborn weight of 4,000 g or more were risk factors for cesarean section among diabetic pregnancies. The maternal complications of the study group were preeclampsia, indicated preterm labor, and premature rupture of membranes. The common fetal complications were macrosomia and birth asphyxia. Conclusion: Risk factors of cesarean section among pregnant women with diabetes included preeclampsia and newborn weight of 4,000 g or more. Gestational diabetes increased significantly the maternal and fetal complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of maternal characteristics on the odds of severe maternal morbidity (SMM) through 42 days postpartum. Study Design: We conducted a retrospective observational study of 77 172 births using birth certificate and insurance claims data from the Arkansas All Payers Claims Database, years 2013‐2017, to identify racial disparities associated with SMM for births between April 1, 2014, and November 19, 2017. Methods: Multiple logistic regression was used to examine the effect of sociodemographic factors and clinical comorbidities on the odds of SMM among non‐Hispanic white ("white"), non‐Hispanic Black ("Black"), and Hispanic women. Results: The rate of SMM was 227.41 per 10 000 births, with Black women (330 per 10 000 births; 95% CI: 296.16‐366.38), having a significantly higher rates than white women (197; 95% CI: 171.72‐225.84) and Hispanic women (180; 95% CI: 155.86‐207.54). After adjusting for maternal demographics, birth‐related clinical variables, and comorbidities, SMM remained higher among Black women (aOR 1.37; 95% CI 1.11‐1.70) relative to white women. Conclusions: Comorbidities, socioeconomic factors, and other factors did not fully explain the Black–white disparities in SMM. Persistent disparities in the rates of SMM throughout 42 days postpartum among Black women relative to white women points to the need for higher quality, more equitable care for women of color in the fist months postpartum. [ABSTRACT FROM AUTHOR]

Introduction: Adherence to intrapartum fetal heart rate monitoring (FHRM) for early decision making in high-risk pregnancies remains a global health challenge. COVID-19 has led to disruption of routine intrapartum care in all income settings. This study aims to evaluate the implementation of quality improvement (QI) intervention to improve intrapartum FHRM and birth outcome before and during pandemic. Method and materials: We conducted an observational study among 10,715 pregnant women in a hospital of Nepal, over 25 months. The hospital implemented QI intervention i.e facilitated plan-do-study-act (PDSA) meetings before and during pandemic. We assessed the change in intrapartum FHRM, timely action in high-risk deliveries and fetal outcomes before and during pandemic. Results: The number of facilitated PDSA meetings increased from an average of one PDSA meeting every 2 months before pandemic to an average of one PDSA meeting per month during the pandemic. Monitoring and documentation of intrapartum FHRM at an interval of less than 30 minutes increased from 47% during pre-pandemic to 73.3% during the pandemic (p<0.0001). The median time interval from admission to abnormal heart rate detection decreased from 160 minutes to 70 minutes during the pandemic (p = 0.020). The median time interval from abnormal FHR detection to the time of delivery increased from 122 minutes to 177 minutes during the pandemic (p = 0.019). There was a rise in abnormal FHR detection during the time of admission (1.8% vs 4.7%; p<0.001) and NICU admissions (2.9% vs 6.5%; p<0.0001) during the pandemic. Conclusion: Despite implementation of QI intervention during the pandemic, the constrains in human resource to manage high risk women has led to poorer neonatal outcome. Increasing human resources to manage high risk women will be key to timely action among high-risk women and prevent stillbirth. [ABSTRACT FROM AUTHOR]

Background: Gestational Trophoblastic Disease (GTD) comprises pathological forms of placental trophoblastic tissue proliferation. When benign, they present with hydatidiform moles, and when malignant, they are called Gestational Trophoblastic Neoplasia. With the growth of the practice of digital health, allied to updated therapeutic approaches, the Outpatient Clinic for Gestational Trophoblastic Disease has built a Health Information System (HIS), contributing to the teaching-learning binomial, as well as to self-care.Methods: This is a cross-sectional and blind technological assessment research for developing SIS-Mola (Website for the medical team and the Application "MolaApp" aimed at patients with GTD). We used the Praxis management approach to manage the application creation project. In the tasks involving real-time chat, a WebSocket layer was created and hosted together with the project's web services, which use the Arch Linux operating system. For the evaluations, we provided questionnaires developed based on the System Usability Scale (SUS), to determine the degree of user satisfaction, with objective questions on the Likert scale. We invited 28 participants for the evaluations, among ABDTG specialist physicians, doctors from the DTG Outpatient Clinic team, and the patients. The study was systematized according to the rules of treatment and follow-up in treating the disease.Results: The tests were conducted from November 2021 to February 2022. The responses obtained on a Likert scale indicated reliability and credibility to the HIS, since the total usability score, measured by the ten questions of the SUS instrument, had a mean of 81.1 (clinicians), 80 (patients) and median of 77.5 for both groups. The sample was characterized according to the variables: age, gender, education, computer knowledge, and profession.Conclusion: Developing a HIS in the GTD Outpatient Clinic met the objectives regarding the rules of treatment and follow-up of patients. With these digital tools, it is possible to obtain data about the patient's health, sending information through exams performed and appropriate treatments. The connectivity capacity allows agile care, saving time, costs and solving the displacement problem. The TICs generate natural efficiency for the organization in the flow of service and the formation of a database, improving the quality of the assistance. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of maternal coronavirus disease 2019 (COVID-19) on prematurity, birthweight and obstetric complications.Design: Nationwide, population-based retrospective cohort study.Setting: National Programme de Médicalisation des Systèmes d'Information database in France.Population: All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID-19 in the mother and/or the newborn.Methods: The group with COVID-19 was compared with the group without COVID-19 using the chi-square test or Fisher's exact test, and the Student's t test or Mann-Whitney U test. Logistic regressions were used to study the effect of COVID-19 on the risk of prematurity or macrosomia (birthweight ≥4500 g).Main Outcome Measures: Prematurity less than 37, less than 28, 28-31, or 32-36 weeks of gestation; birthweight; obstetric complications.Results: In singleton pregnancies, COVID-19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p < 0.01), pre-eclampsia (3.6% versus 2.0%, p < 0.01), diabetes (18.8% versus 14.4%, p < 0.01) and caesarean delivery (26.8% versus 19.7%, p < 0.01). Among pregnant women with COVID-19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p < 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p < 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small-for-gestational-age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55-2.01) for COVID-19. For macrosomia, COVID-19 resulted in non-significant aOR of 1.38 (95% CI 0.95-2.00).Conclusions: COVID-19 is a risk factor for prematurity, even after adjustment for other risk factors.Tweetable Abstract: The risk of prematurity is twice as high in women with COVID-19 after adjustment for factors usually associated with prematurity. [ABSTRACT FROM AUTHOR]

Introduction: Conflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the coronavirus disease 2019 (COVID‐19) pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta‐analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre‐pandemic periods. Material and methods: We searched PubMed and Embase databases, reference lists of articles published up until August 14, 2021 and included English language studies that compared outcomes between the COVID‐19 pandemic time period and the pre‐pandemic time periods. Risk of bias was assessed using the Newcastle–Ottawa scale. We conducted random‐effects meta‐analysis using the inverse variance method. Results: Forty‐five studies with low‐to‐moderate risk of bias, reporting on 1 843 665 pregnancies during the pandemic period and 23 564 552 pregnancies during the pre‐pandemic period, were included. There was significant reduction in unadjusted estimates of PTB (35 studies, unadjusted odds ratio [uaOR] 0.95, 95% CI 0.92–0.98), but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80–1.13). This reduction was noted in studies from single centers/health areas (25 studies, uaOR 0.90, 95% CI 0.86–0.96) but not in regional/national studies (10 studies, uaOR 0.99, 95% CI 0.95–1.02). There was reduction in spontaneous PTB (six studies, uaOR 0.89, 95% CI 0.81–0.96) and induced PTB (five studies, uaOR 0.89, 95% CI 0.81–0.97). There was no difference in the odds of stillbirth between the pandemic and pre‐pandemic time periods (24 studies, uaOR 1.11, 95% CI 0.97–1.26 and four studies, aOR 1.06, 95% CI 0.81–1.38). There was an increase in mean birthweight during the pandemic period compared with the pre‐pandemic period (six studies, mean difference 17 g, 95% CI 7–28 g). The odds of maternal mortality were increased (four studies, uaOR 1.15, 95% CI 1.05–1.26); however, only unadjusted estimates were available and the result was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB. Conclusions: The COVID‐19 pandemic may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no statistically significant difference in stillbirth between pandemic and pre‐pandemic periods. [ABSTRACT FROM AUTHOR]