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Management of Pregnancy Complications: 2nd Edition
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Management of Pregnancy Complications: 2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (20 February 2026) | Viewed by 6828

Special Issue Editor

Prof. Dr. Ariel Many

E-Mail Website
Guest Editor
1. Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak 51544, Israel
2. Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
Interests: high-risk pregnancy; preterm labor; fetal growth restriction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to this Special Issue on the “Management of Pregnancy Complications: 2nd Edition”, which follows the success of the first volume, comprising 10 papers. For more details, please visit https://www.mdpi.com/journal/jcm/special_issues/50P73F5MQB.

We are seeking papers on the topic of high-risk pregnancies, complications, and innovative treatments. In these pregnancies, the mother, the fetus, or both are at increased risk of complications or adverse outcomes, including preterm labor, preeclampsia, diabetes, fetal growth restriction, and many other medical and environmental conditions.

We welcome original research articles, reviews, case reports, and perspectives on any aspect of high-risk pregnancies, including (but not limited to) the following:

  • Identification and management of high-risk pregnancies;
  • Predictive factors for adverse outcomes in high-risk pregnancies;
  • Novel diagnostic tools and interventions for high-risk pregnancies;
  • Innovative genetic and other fetal diagnostic tools;
  • Long-term outcomes for mothers and babies after high-risk pregnancies;
  • High-risk deliveries, complications, and treatments;
  • Ethical considerations in managing high-risk pregnancies.

We welcome submissions from obstetricians, gynecologists, maternal-fetal medicine specialists, neonatologists, geneticists, endocrinologists, epidemiologists, and other researchers interested in high-risk pregnancies.

All submitted papers will undergo a rigorous peer-review by our expert reviewer panel before being published in this Special Issue. We look forward to receiving your contributions.

Prof. Dr. Ariel Many
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • high-risk pregnancy
  • preterm labor
  • fetal growth restriction
  • gestational diabetes
  • twins
  • hypertensive disorders during pregnancy
  • preeclampsia
  • IUGR
  • prenatal genetics
  • congenital anomaly detection
  • cesarean section
  • complications of labor and delivery

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Related Special Issue

Published Papers (4 papers)

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Research

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10 pages, 609 KB  
Article
Prediction Model for Failed Vacuum Assisted Delivery: A Retrospective Cohort Study
by Itamar Gilboa, Daniel Gabbai, Lee Reicher, Emmanuel Attali, Yariv Yogev and Anat Lavie
J. Clin. Med. 2026, 15(7), 2522; https://doi.org/10.3390/jcm15072522 - 26 Mar 2026
Viewed by 350
Abstract
Background/Objectives: We aimed to determine risk factors and to design a clinically based predictive model for a failed vacuum assisted delivery (VAD). Methods: We conducted a retrospective cohort study in a single tertiary university-affiliated medical center between 2011 and 2023. The [...] Read more.
Background/Objectives: We aimed to determine risk factors and to design a clinically based predictive model for a failed vacuum assisted delivery (VAD). Methods: We conducted a retrospective cohort study in a single tertiary university-affiliated medical center between 2011 and 2023. The study population consisted of singleton pregnancies with a VAD trial. The study group comprised cases of a failed VAD, defined as the occurrence of any of the following: (1) more than two vacuum cup detachments; (2) extraction duration exceeding 20 min; or (3) abandonment of the vacuum attempt by the operating physician, with conversion to urgent cesarean delivery (CD). The control group comprised cases of successful VADs. Factors associated with failed VAD were examined by univariate and multivariate analyses. A prediction score was developed to predict failed VAD. A receiver-operating characteristic curve (ROC) was utilized for the model. Internal validation was performed by means of a 70/30 train–test split, with model performance evaluated on the validation set using ROC analysis. Results: A total of 131,019 women delivered in our center during the study period. VAD was attempted in 8885 (6.8%) cases, of which 172 (1.9%) failed trials that led to urgent CDs. Several risk factors for a failed VAD were identified, including induction of labor, fetal head station below +2 cm relative to the ischial spines, duration of the second stage of delivery >3.5 h, preeclampsia, birthweight >3750 g, and male gender. The prediction score demonstrated good discriminatory performance, with an AUC of 0.723 (95% CI 0.637–0.810). Internal validation using a 30% holdout cohort revealed that the model maintained good performance, with an AUC of 0.764 (95% CI 0.619–0.909; p < 0.001). Conclusions: Our model has the potential to assist obstetricians with VAD decision-making and parturient counseling, as well as identifying parturients at high risk for complicated deliveries. Full article
(This article belongs to the Special Issue Management of Pregnancy Complications: 2nd Edition)
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12 pages, 221 KB  
Article
Defining the Timing Window: Week- and Interval-Specific Effects of Antenatal Betamethasone in Late-Preterm Births
by Karin Edut, Ella Segal, Miriam Lopian, Ariel Many and Shanny Kolp-Asis
J. Clin. Med. 2026, 15(4), 1605; https://doi.org/10.3390/jcm15041605 - 19 Feb 2026
Viewed by 462
Abstract
Objectives: To evaluate the association between antenatal betamethasone exposure and neonatal respiratory morbidity among late-preterm births. We further examined whether gestational age at delivery and the exposure-to-delivery interval modify this association. Methods: We conducted a retrospective cohort study of singleton live births at [...] Read more.
Objectives: To evaluate the association between antenatal betamethasone exposure and neonatal respiratory morbidity among late-preterm births. We further examined whether gestational age at delivery and the exposure-to-delivery interval modify this association. Methods: We conducted a retrospective cohort study of singleton live births at 34–36 + 6 weeks in a tertiary center (2011–2023). Betamethasone exposure was classified as none, early (<34 weeks), or late (34–36 + 6 weeks). Among exposed pregnancies, the interval from first dose to delivery was categorized as ≤7 or >7 days and evaluated separately at 34, 35, and 36 weeks. Primary outcomes were RDS and composite respiratory morbidity (RDS, TTN, or ≥3 days of respiratory support); neonatal hypoglycemia was secondary. Adjusted odds ratios were estimated using multivariable logistic regression including maternal age, parity, delivery mode, and birthweight. Results: The study included 2668 late-preterm infants, of whom 2356 (88.3%) were unexposed and 312 (11.7%) were exposed to antenatal corticosteroids (ACSs). Among exposed pregnancies, 138 (44.2%) received early ACS and 174 (55.8%) late ACS; 163 (52.2%) delivered ≤7 days and 149 (47.8%) >7 days after administration. Late ACS exposure was associated with lower odds of RDS (aOR 0.37, 95% CI 0.17–0.69) and composite respiratory morbidity (aOR 0.55, 95% CI 0.31–0.92), but with increased odds of neonatal hypoglycemia (aOR 2.72, 95% CI 1.26–5.31). Among pregnancies delivering at 34 weeks, exposure within ≤7 days was associated with a marked reduction in RDS (aOR 0.25, 95% CI 0.07–0.79; NNT ≈ 3), whereas no respiratory benefit was observed at 35 or 36 weeks or when the interval exceeded 7 days. Conclusions: Antenatal betamethasone exposure among late-preterm births was not uniformly associated with neonatal respiratory outcomes, with associations varying by gestational age at delivery and the exposure-to-delivery interval. These findings may be interpreted in the context of potential respiratory benefit alongside accompanying metabolic risk, with exploratory analyses suggesting a more pronounced signal among deliveries at 34 weeks within ≤7 days. Full article
(This article belongs to the Special Issue Management of Pregnancy Complications: 2nd Edition)
17 pages, 880 KB  
Article
Dysregulation of Treg/Th17 Balance and Intracellular Expression of IL-21 and IL-22 in the Pathogenesis of Gestational Hypertension
by Maciej Kwiatek, Wojciech Kwaśniewski, Tomasz Gęca, Ewelina Grywalska, Mansur Rahnama-Hezavah, Sebastian Mertowski, Tomasz Urbanowicz, Magdalena Ewa Kowalkowska, Maciej Krasiński, Anna Kwaśniewska and Maciej Brązert
J. Clin. Med. 2025, 14(20), 7288; https://doi.org/10.3390/jcm14207288 - 15 Oct 2025
Cited by 2 | Viewed by 1287
Abstract
Background/Objectives: Pregnancy-induced hypertension (PIH), including preeclampsia (PE), remains a significant cause of maternal and fetal morbidity. Immune imbalance involving T helper (Th17) and regulatory T (Treg) cells is increasingly recognized as contributing to the pathogenesis of PIH. This study aimed to assess the [...] Read more.
Background/Objectives: Pregnancy-induced hypertension (PIH), including preeclampsia (PE), remains a significant cause of maternal and fetal morbidity. Immune imbalance involving T helper (Th17) and regulatory T (Treg) cells is increasingly recognized as contributing to the pathogenesis of PIH. This study aimed to assess the proportions of Th17 and Treg cells and intracellular cytokine expression (IL-17A, IL-17F, IL-21, and IL-22) in the peripheral blood of hypertensive versus normotensive pregnant women. Methods: A total of 108 pregnant women were included: 60 with hypertensive disorders and 48 normotensive controls. Peripheral blood mononuclear cells were analyzed using multiparametric flow cytometry to quantify CD4+CD25+FoxP3+ Treg and CD4+IL-17A+ Th17 cells, along with intracellular IL-17F, IL-21, and IL-22 co-expression. Correlations with clinical and obstetric parameters were evaluated. Results: Hypertensive patients showed significantly increased proportions of activated Th17 cells (CD4+IL-17A+) and Th17 subpopulations co-expressing IL-17F and IL-22, as well as IL-21 and IL-22 (p < 0.0001). Although Treg cell percentages were lower in the hypertensive group, the difference was not statistically significant. A pronounced Th17/Treg imbalance was observed. Positive correlations were found between Th17 subpopulations and gestational age, birth weight, and length, as well as maternal age. Conclusions: The immune profile in hypertensive pregnancies was characterized by a shift toward Th17-mediated proinflammatory responses, supporting the role of immune dysregulation in PIH. The increased frequency of Th17 cells co-expressing IL-21 and IL-22 may serve as a potential biomarker of disease severity and warrants further exploration. Full article
(This article belongs to the Special Issue Management of Pregnancy Complications: 2nd Edition)
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20 pages, 1529 KB  
Systematic Review
Pregnancy-Related Acute Kidney Injury: Causes and Its Impact on Perinatal Outcomes—A Systematic Review
by Emmanuel N. Kontomanolis, Ioannis Prokopakis, Antonios Koutras, Emmanouil Andreou, Dionysios Metaxas, Gerasimos Boulieris, Eleftherios Zachariou, Ioakeim Sapantzoglou, Dimitrios Papageorgiou, Vasileios-Chrysovalantis Palios, Charalampos Karachalios, Angeliki Papadimitriou, Konstantinos Daglas, Athanasios Chionis, Antonios Lagadas and Paraskevas Perros
J. Clin. Med. 2025, 14(17), 6031; https://doi.org/10.3390/jcm14176031 - 26 Aug 2025
Cited by 3 | Viewed by 4163
Abstract
Background: Pregnancy-Related Acute kidney injury (PRAKI) is a critical complication of pregnancy, defined by the sudden deterioration in renal function during gestation or within the initial six weeks postpartum. Pregnancy is thought to increase the risk of acute kidney injury (AKI) by 51%. [...] Read more.
Background: Pregnancy-Related Acute kidney injury (PRAKI) is a critical complication of pregnancy, defined by the sudden deterioration in renal function during gestation or within the initial six weeks postpartum. Pregnancy is thought to increase the risk of acute kidney injury (AKI) by 51%. This is linked to the anatomical alterations that occur during pregnancy and special conditions, such as preeclampsia/eclampsia. PRAKI’s epidemiology and outcome vary between developed and developing nations. PRAKI is an uncommon entity in high-income countries; however, its incidence has recently increased. The aim of this systematic review is to evaluate the maternal and perinatal outcomes and risk factors affecting pregnancies affected by AKI. Methods: Comprehensive research was performed in PubMed/Medline, Scopus, and Google Scholar electronic databases from 2015 up to January 2025, using the terms AKI, PRAKI, sepsis, preeclampsia/eclampsia, liver enzymes, low platelet count (HELLP) syndrome, and pregnancy. After a thorough assessment, 25 full-text articles were obtained. Results: Our results revealed that preeclampsia, eclampsia, HELLP syndrome, and antepartum and postpartum hemorrhage predispose women to PRAKI. Other unusual factors, like disseminated intravascular coagulation (DIC) or hemolytic uremic syndrome (HUS), should not be underestimated. Furthermore, the latest published data showed unfavorable maternal and fetal outcomes in pregnancies affected by AKI compared to the general population. Conclusions: PRAKI constitutes a serious pregnancy complication that requires immediate treatment. The higher prevalence of PRAKI in developing countries (4–26%) versus wealthy nations (1.0–2.8%) has considerably indicated the impact of socioeconomic status and the accessibility of health services. Full article
(This article belongs to the Special Issue Management of Pregnancy Complications: 2nd Edition)
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