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Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions

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

Deadline for manuscript submissions: 10 September 2025 | Viewed by 11580

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Special Issue Editors

Dr. Demetra Socolov

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Department of Obstetrics and Gynecology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
Interests: maternal–fetal medicine; in utero fetal surgery; prenatal diagnosis; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Iuliana Ceausu

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Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, "Dr I. Cantacuzno" Hospital, 020021 Bucharest, Romania
Interests: Biomarkers in obstetrics and gynaecology; gestational diabetes; maternal obesity; autoimmune diseases and pregnancy; preeclampsia; fetal medicine

Dr. Elena Bernad

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Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
Interests: gynecology; obstetrics; gynecological oncology; endocrinology and reproductive medicine; ethics; medical education; research design; epidemiology and statistics; computer applications
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Adverse pregnancy outcomes pose a substantial challenge for obstetricians, with long-term consequences on maternal and neonatal health, including neurological injuries as well as cardiovascular and metabolic disorders. Current screening strategies and prophylactic measures have substantially influenced the incidence of these adverse outcomes. However, recent advancements in detection rates of obstetrical disorders using various biochemical, sonographic, genomic, and proteomic markers, as well as advanced screening algorithms powered by artificial intelligence, need to be highlighted.

This Special Issue, entitled “Adverse Pregnancy Outcomes: Current Status, Challenges, and Future Directions,” will focus on recent advancements in the screening, prediction, and diagnosis of maternal and neonatal outcomes in the context of preeclampsia, intrauterine growth restriction, preterm birth, gestational diabetes, and intraamniotic infections. Additionally, it will support the peer review of manuscripts that describe the prenatal and intrapartum management of high-risk pregnancies and their outcomes.

We welcome high-quality and informative original studies (clinical and experimental), meta-analyses, reviews, clinical cases, and expert opinions. We look forward to receiving your contributions!

Dr. Demetra Socolov
Prof. Dr. Iuliana Ceausu
Dr. Elena Bernad
Guest Editors

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Keywords

great obstetrical syndromes
adverse pregnancy outcomes
screening
prediction
prophylaxis
diagnosis
long-term follow-up
perinatal management
intrapartum management

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Published Papers (10 papers)

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Research

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11 pages, 244 KiB

Open AccessArticle

Birth Outcomes in Pregnancies with Uterine Malformations: A Single-Center Retrospective Study

by Corneliu Florin Buicu, Melinda Ildiko Mitranovici, Dan Dumitrascu Biris, Marius Craina and Elena Silvia Bernad

J. Clin. Med. 2025, 14(7), 2379; https://doi.org/10.3390/jcm14072379 - 30 Mar 2025

Viewed by 513

Abstract

Background and objectives: The prevalence of uterine malformations, affecting up to 7% of the general population, is associated with high rates of pregnancy complications, such as infertility, miscarriage, preterm delivery, malpresentation, ectopic pregnancy, and other complications, with high rates of both maternal and fetal morbidity and mortality. Surgical procedures have been proposed to remediate these anomalies, with different outcomes. In this context, our study aimed to emphasize the complications encountered in our department and the pregnancy results. Materials and Methods: A retrospective cohort study was performed on all the women who delivered in one university-affiliated medical center between 2010 and 2017 with congenital uterine malformations. A total of 62 women were included: 26 with uterine malformations and 36 as controls. Statistical analyses were performed with the level of statistical significance set at p < 0.05. Results: Only 53.8% of the pregnancies in women with uterine malformations ended in a live birth. The cesarean section rate was 64.3% in the study group. The only successful surgical procedure performed to restore fertility was cerclage. A lower Apgar score and a higher rate of neonate admission into the intensive care unit were observed in the study group, at 11.5% compared to 0 in the control group. The most important complication encountered with statistical significance was preterm delivery. Conclusions: This study demonstrated that uterine congenital malformations are an independent risk factor for pregnancy complications. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

9 pages, 1286 KiB

Open AccessArticle

Assessment of Cerebral Hemodynamic Changes During Roll-Over Test in Healthy Pregnant Women and Those with Mild and Severe Preeclampsia

by Dániel T. Nagy, Béla Fülesdi, Bence Kozma, Dénes Páll, Szilárd Szatmári and Petronella Hupuczi

J. Clin. Med. 2025, 14(4), 1182; https://doi.org/10.3390/jcm14041182 - 11 Feb 2025

Cited by 1 | Viewed by 766

Abstract

Background: Preeclampsia (PE) and eclampsia are characterized by changes in cerebral hemodynamics, which may result in serious and even life-threatening neurological complications. The aim of the present work was to compare cerebral hemodynamic changes during the roll-over test in women with mild and severe PE. Patients and methods: Healthy pregnant and PE women in their third trimester were studied. Transcranial Doppler (TCD) measurements of the right middle cerebral artery (MCA) were performed in the left lateral position and 5 min after turning to the supine position (roll-over test = ROT). Besides cerebral blood flow measurements, the blood pressure was measured in the right arm using a standard mercury sphygmomanometer. An independent gynecologist categorized the preeclamptic patients into mild and severe groups based on the clinical and laboratory results. The TCD assessors were unaware of the patient grouping while performing the TCD and blood pressure measurements. Results: A total of 21 healthy pregnant females (mean age: 26.1 ± 5.1 yrs), 11 females with mild PE (28.2 ± 6.8 yrs), and 18 females with severe PE (29 ± 7.4 yrs) were studied. A significant increase in the mean arterial pressure was observed in all of the groups during the roll-over test: healthy pregnant patients: from 106.3 ± 16.3 to 113.8 ± 15.9 mmHg; patients with mild PE: from 100 ± 11.2 to 110 ± 8.7 mmHg; and patients with severe PE: from 106.3 ± 16.3 to 113.8 ± 15.8 mmHg. The MCA mean blood flow velocities in the left lateral position were significantly lower in the control patients than in those with PE: MCAV control: 71.2 ± 12.7 cm/s; mild PE: 78.2 ± 19.4 cm/s; and severe PE: 96 ± 15.6 cm/s, p < 0.001. Turning to the supine position resulted in a decrease in the MCAV in all of the groups, but the differences between the groups remained unchanged: controls: 69.5 ± 9.1 cm/s; mild PE: 75.7 ± 17.5 cm/s; and severe PE: 85.7 ± 18.4 cm/s, respectively, p = 0.014. A slight but statistically insignificant increase in the pulsatility index was observed in all of the groups. Conclusions: This is the first study comparing cerebral hemodynamic changes in healthy pregnant females and in those with mild and severe PE during a roll-over test. Changing the posture did not result in changes in the cerebral blood flow velocities in the healthy and preeclamptic pregnant patients. Our results indicate that static cerebral autoregulation is preserved both in the mild and severe preeclamptic patients. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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17 pages, 776 KiB

Open AccessArticle

Awareness and Knowledge About Preconception Healthcare: A Cross-Sectional Study of Early Years UAE Medical Students

by Sara Maki, Shamsa Al Awar, Sara Alhosani, Latifa Alshamsi, Shamma Alzaabi, Mohammad Ali Alsaadi, Mahra Alhammadi, Hamad Alhosani, Gehan Sayed Salam, Stanisław Wójtowicz and Kornelia Zaręba

J. Clin. Med. 2025, 14(1), 181; https://doi.org/10.3390/jcm14010181 - 31 Dec 2024

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Abstract

Background: Preconception health is critical for improving maternal and child health. The main objective of the study was to explore medical students’ health habits, quality of life, and knowledge of preconception healthcare. Methods: We conducted a cross-sectional study between 15 March 2023 and 31 May 2024 among medical students at United Arab Emirates University. To determine awareness and knowledge of preconception health, we administered a survey consisting of an author’s questionnaire with 35 questions covering sociodemographic characteristics and general knowledge of preconception health, as well as the WHO Quality of Life Scale-BREF (WHOQOL-BREF). Results: The participants were predominantly under 25 years old (98.5%), Emirati (91.1%), single (92.6%), and female (95.8%); only 3.4% had been pregnant before. Regarding health awareness and behaviors, a significant number of females (58.0%) had never visited a gynecologist. The majority of students (72.4%) participated in sports activities. The overall level of knowledge was low, with a mean level of 7.5 (SD = 6.36) out of 24. The Internet (webpages, blogs, webinars) (64.5%) was the major source of knowledge regarding healthcare information, followed by social media platforms (Twitter, Facebook, TikTok, Instagram) and mobile applications (57.5%), books (48.6%), and family members (57.0%). There was a statistically significant correlation between knowledge levels and the Internet (p < 0.004) or family (p < 0.001) as a source of knowledge. Additionally, there was a statistically significant positive correlation between knowledge and quality of life across all four WHOQOL domains. Conclusions: Medical knowledge might positively affect general well-being. Fostering stronger social networks and support systems could benefit preconceptional awareness and knowledge. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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9 pages, 794 KiB

Open AccessArticle

Risk Assessment for Preeclampsia in the Preconception Period Based on Maternal Clinical History via Machine Learning Methods

by Yeliz Kaya, Zafer Bütün, Özer Çelik, Ece Akça Salik and Tuğba Tahta

J. Clin. Med. 2025, 14(1), 155; https://doi.org/10.3390/jcm14010155 - 30 Dec 2024

Cited by 2 | Viewed by 836

Abstract

Objective: This study was aimed to identify the most effective machine learning (ML) algorithm for predicting preeclampsia based on sociodemographic and obstetric factors during the preconception period. Methods: Data from pregnant women admitted to the obstetric clinic during their first trimester were analyzed, focusing on maternal age, body mass index (BMI), smoking status, history of diabetes mellitus, gestational diabetes mellitus, and mean arterial pressure. The women were grouped by whether they had a preeclampsia diagnosis and by whether they had one or two live births. Predictive models were then developed using five commonly applied ML algorithms. Results: The study included 100 mothers divided into four groups: 22 nulliparous mothers with preeclampsia, 25 nulliparous mothers without preeclampsia, 28 parous mothers with preeclampsia, and 25 parous mothers without preeclampsia. Analysis showed that maternal BMI and family history of diabetes mellitus were the most significant predictive variables. Among the predictive models, the extreme gradient boosting (XGB) classifier demonstrated the highest accuracy, achieving 70% and 72.7% in the respective groups. Conclusions: A predictive model utilizing an ML algorithm based on maternal sociodemographic data and obstetric history could serve as an early detection tool for preeclampsia. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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11 pages, 252 KiB

Open AccessArticle

Multidrug-Resistant Urinary Tract Infections in Pregnant Patients and Their Association with Adverse Pregnancy Outcomes—A Retrospective Study

by Gabriel-Ioan Anton, Liliana Gheorghe, Viorel-Dragos Radu, Ioana-Sadiye Scripcariu, Ingrid-Andrada Vasilache, Alexandru Carauleanu, Iustina-Solomon Condriuc, Razvan Socolov, Pavel Onofrei, Andreea-Ioana Pruteanu, Ramona-Gabriela Ursu, Tudor Gisca and Demetra Socolov

J. Clin. Med. 2024, 13(22), 6664; https://doi.org/10.3390/jcm13226664 - 6 Nov 2024

Cited by 2 | Viewed by 1375

Abstract

Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant women, as well as their impact on obstetrical and neonatal outcomes. Methods: A total of 371 pregnant patients with UTIs were included in the analysis and were segregated into the following groups based on the type of bacterial resistance to antibiotics: MDR UTIs (70 patients, group 1), UTIs resistant to one class of antibiotics (108 patients, group 2), UTIs resistant to two classes of antibiotics (102 patients, group 3), and sensitive UTIs (91 patients, group 4). We used descriptive statistics for characterizing and comparing the microbial spectrum and the clinical characteristics of the patients. A multinomial logistic regression model for evaluating the relationship between the type of urinary tract infection and adverse obstetric or neonatal outcomes was employed. Results: In the case of MDR UTIs, the bacterial spectrum mainly included Escherichia coli, Enterococcus faecalis, and Klebsiella species. We found almost universal resistance to ampicillin. Our data confirmed an increased risk of preterm birth, premature rupture of membranes, neonatal respiratory distress syndrome, and neonatal intensive care unit admission for patients with MDR infections. Conclusions: The increased incidence of pathogens resistant to commonly used antibiotic classes in pregnancy suggests the need for the development of local and national protocols that adapt therapeutic and prophylactic regimens to clinical realities. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

12 pages, 423 KiB

Open AccessArticle

Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study

by Irene Aracil Moreno, Raquel Prieto-Arévalo, Virginia Ortega-Abad, Virginia Martín-Manzano, Laura Pérez-Burrel, Andrea Fraile-López, Carolina Devesa-Cordero, Fátima Yllana-Pérez, Miguel A. Ortega and Juan A. De León-Luis

J. Clin. Med. 2024, 13(17), 5084; https://doi.org/10.3390/jcm13175084 - 27 Aug 2024

Viewed by 1938

Abstract

Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case–control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66–4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32–49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02–8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09–3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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Review

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14 pages, 7140 KiB

Open AccessReview

Clinical Significance and Prognosis of Prenatal Diagnosis of Large Umbilical Cord Cysts—A Review Triggered by a Clinical Case

by Șerban Nastasia, Adina Elena Nenciu, Manuela Cristina Russu, Adrian Valeriu Neacșu, Iuliana Ceaușu and Nicoleta Adelina Achim

J. Clin. Med. 2025, 14(8), 2564; https://doi.org/10.3390/jcm14082564 - 8 Apr 2025

Viewed by 527

Abstract

Background/Objectives: Prevalence of umbilical cord cysts is largely unknown, mainly due to small dimensions and to the fact that only placental and fetal insertion of the umbilical cord are usually assessed. Older studies report a total prevalence of about 3%, regardless of the size. To date, no correlation between the gestational age, the size of the cyst at the moment of diagnosis and pregnancy prognosis can be made. Methods: We managed a case of a large umbilical cyst diagnosed in the first trimester. As our experience with this pathology was limited, we performed a systematic review in order to find out the optimal management. Results: We report a case of a large umbilical cord cyst that ended in fetal demise at 13 weeks in the absence of any chromosomal and structural anomalies. Our results differ from what was expected from our literature review. Sixteen papers were included in our analysis. According to the selected papers, single cysts are more frequent than multiple cysts (79% single cysts). The mean value of the maximum diameter of the cyst was 32 mm, and there was no difference in number considering the localization of the cyst. Considering the cases in which genetic testing was performed, there were 22.76% modified results. The most frequent genetic disorder was trisomy 18 (53.57% from the modified results). Conclusions: Large umbilical cord cysts are correlated with uncertain prognosis. We made the conclusion that large umbilical cord cystic lesions might have an unfavorable prognosis. Although there are case series that have shown an unproblematic evolution of the pregnancy, large umbilical cysts could be associated with increased risk of fetal anomalies and intrauterine fetal death. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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19 pages, 251 KiB

Open AccessReview

Navigating the Complex Terrain of Obstetrics and Gynecology Malpractice: Stakeholders, Expectations, and Legal Implications

by Lavinia Toma-Tumbar, Rodica Daniela Nagy, Marius Cristian Marinaș, Dominic Gabriel Iliescu and Monica Laura Cara

J. Clin. Med. 2025, 14(7), 2266; https://doi.org/10.3390/jcm14072266 - 26 Mar 2025

Viewed by 391

Abstract

This narrative review delves into the multifaceted landscape of obstetric and gynecological malpractice, focusing on stakeholders’ expectations, legal implications, and clinical considerations. Through a comprehensive analysis of the relevant literature, we evaluated 25 articles, culminating in a comprehensive understanding of the primary drivers behind malpractice litigation in this field. The review highlights the complex nature of these issues and their implications for various stakeholders. The key findings reveal the critical role of meeting medical care standards to avoid harm to patients, along with factors such as diagnostic errors, mismanagement of complications, and deficiencies in patient counseling contributing to malpractice allegations. Additionally, issues related to surgical procedures, informed consent, and documentation are explored. The review underscores the importance of collaboration, education, and accountability in mitigating the impact of malpractice and upholding patient safety in obstetric and gynecological practice. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

13 pages, 726 KiB

Open AccessReview

Maternal and Fetal Complications in Pregnant Women with Neurofibromatosis Type 1: Literature Review and Two Case Reports

by Ancuta Nastac, Anca Maria Panaitescu, Iulia Huluță, Nicolae Gică, Gabriel-Petre Gorecki, Radu Botezatu, Cristina Violeta Tutunaru, Vlad Mihai Voiculescu and Florina Mihaela Nedelea

J. Clin. Med. 2025, 14(2), 451; https://doi.org/10.3390/jcm14020451 - 12 Jan 2025

Viewed by 1889

Abstract

Neurofibromatosis is a genetic disorder arising de novo or with an autosomal dominant transmission that typically presents either at birth or in early childhood, manifesting through distinctive clinical features such as multiple café-au-lait spots, benign tumors in the skin, bone enlargement, and deformities. This literature review aims to resume the spectrum of maternal and fetal complications encountered in pregnant women with neurofibromatosis type 1 (NF1). Thorough research was conducted on databases such as Web of Science, PubMed, Science Direct, Google Scholar, and Wiley Online Library. This review includes 48 case reports, original studies, and reviews on NF1 in pregnancy. The research on the interlink between NF1 and fertility and its influence on human-assisted reproduction techniques is limited. Preimplantation testing (by in vitro fertilization) and prenatal diagnosis (by chorionic villus sampling or amniocentesis) are available to detect affected fetuses. However, genotype–phenotype correlation is difficult to predict. Preconceptional planning and targeted investigations are crucial in understanding the extent of maternal disease. Although in some cases lesions can evolve rapidly during pregnancy, most pregnancies and births in NF1 go well with careful planning. There is a higher incidence of pheochromocytomas and pre-eclampsia, vascular rupture, and cardio-respiratory issues. Anesthesia at birth is a challenge in most cases, and before offering spinal anesthesia, imaging tests should be performed to characterize spinal lesions. General anesthesia may also be challenging when the disease affects the face, neck, upper spine, or airways. Birth-related difficulties may arise because of large neurofibromas located at the level of skin incision or birth canal; uterine atony may be expected if there are uterine lesions. Some complications can develop in postpartum, and affected women should be carefully followed even after pregnancy. Fetal risks include preterm birth (spontaneous or iatrogenic), growth restriction and developmental issues, birth complications, cardiovascular risk, and fetal/neonatal demise. Pregnancies in women with NF1 should be regarded as high-risk and followed in a multidisciplinary fashion. Careful assessment of lesions is of utmost importance before and during pregnancy for anticipating potential maternal risks and before birth to plan anesthesia and delivery. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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14 pages, 764 KiB

Open AccessReview

Pre-Pregnancy Counselling for Women with Rheumatoid Arthritis: A Guide on Risks, Evaluations, and Multidisciplinary Approaches

by Ioana Cristina Saulescu, Anca Maria Panaitescu, Nicolae Gică, Elena Grădinaru and Daniela Opris-Belinski

J. Clin. Med. 2025, 14(1), 114; https://doi.org/10.3390/jcm14010114 - 28 Dec 2024

Viewed by 1350

Abstract

This paper explores the essential role of pre-pregnancy counselling for women with rheumatoid arthritis (RA), focusing on minimising risks and optimising pregnancy outcomes. RA, a prevalent inflammatory arthritis with onset during childbearing years, necessitates targeted preconception counselling to manage disease activity and comorbidities effectively. The counselling ensures medication compatibility and planning around disease flares, and it involves a multidisciplinary team comprising rheumatologists, obstetricians, and other specialists to develop individualised care plans. This literature review highlights the challenges women with RA face, including prolonged time to pregnancy, increased risks during pregnancy, such as hypertension and preeclampsia, and potential fertility issues related to medication and disease activity. Emphasis is placed on the importance of assessing autoantibody presence and managing specific joint involvements that may affect anaesthetic procedures during pregnancy. This paper underscores the importance of timing conception during periods of low disease activity and adopting a “Treat-to-Target” approach using acceptable medications to maintain disease remission. This study calls for routine family planning discussions and preconception evaluations to address reproductive health and treatment plans, thereby supporting women with RA in achieving favourable pregnancy outcomes comparable to the general population. The multidisciplinary approach and regular counselling are critical to navigating the complexities of RA and pregnancy successfully. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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