Submit to Special Issue Submit Abstract to Special Issue Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

Pregnancy Complications and Maternal-Perinatal Outcomes

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

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

Deadline for manuscript submissions: 30 June 2026 | Viewed by 5553

Share This Special Issue

Special Issue Editor

Dr. Angelo Sirico

E-Mail Website
Guest Editor

Institute of Gynaecology and Obstetrics, University of Campania “Luigi Vanvitelli”, Caserta, Italy
Interests: gestational diabetes; macrosomia; preeclampsia; ultrasound; Doppler; placenta; immunohistochemistry; fetal growth restriction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pregnancy is a dynamic and complex physiological process that can be affected by a wide range of maternal and fetal complications. Conditions such as gestational diabetes mellitus (GDM), preeclampsia, fetal growth restriction (FGR), and other high-risk pregnancy factors continue to represent major causes of maternal and perinatal morbidity and mortality worldwide. The aim of this Special Issue is to gather high-quality original research articles, systematic reviews, and clinical studies focusing on the clinical pathophysiology, diagnosis, prevention, and management of pregnancy-related complications. Particular attention will be given to studies exploring the role of the placenta, maternal metabolic status, and the use of ultrasound and other diagnostic tools in monitoring maternal and fetal health. We welcome submissions that enhance the understanding of mechanisms underlying high-risk pregnancies and that propose innovative strategies to improve outcomes for both mothers and newborns.

Dr. Angelo Sirico
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

pregnancy
high-risk
GDM
preeclampsia
fetal growth restriction
diabetes
placenta
ultrasound

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review, Other

28 pages, 1066 KB

Open AccessArticle

PAD Score: A Clinical Prediction Tool for Disseminated Intravascular Coagulation in Placental Abruption

by Resat Misirlioglu, Filiz Yarsilikal Guleroglu and Ali Cetin

J. Clin. Med. 2026, 15(9), 3524; https://doi.org/10.3390/jcm15093524 - 5 May 2026

Viewed by 290

Abstract

Background/Objectives: Placental abruption remains one of the leading causes of maternal morbidity, and the development of disseminated intravascular coagulation (DIC) significantly worsens outcomes. We sought to develop and internally validate a prediction model—the Placental Abruption DIC (PAD) Score—using parameters routinely collected at presentation. Methods: We conducted a retrospective cohort study at a tertiary referral center in Istanbul, Turkey (January 2019–December 2024). Women with singleton pregnancies ≥22 weeks diagnosed with placental abruption were eligible. The primary outcome was overt disseminated intravascular coagulation (DIC) within 24 h of admission, adjudicated using the original International Society on Thrombosis and Haemostasis (ISTH) overt DIC scoring algorithm; a total score of ≥5 was considered compatible with overt DIC. We built a multivariable logistic regression model with bootstrap internal validation (1000 resamples). Robustness was evaluated through prespecified sensitivity analyses including complete-case analysis, single imputation, Firth-penalized logistic regression, exclusion of patients transferred from external facilities, a four-variable model excluding preeclampsia, and alternative score threshold grouping. Comparative discrimination against the admission ISTH overt DIC score, the Erez pregnancy-modified DIC score, and the Kobayashi obstetrical DIC score were evaluated using the area under the receiver operating characteristic curve and DeLong testing. Results: Of 237 women, 54 (22.8%) developed DIC. The final model retained five predictors: fibrinogen concentration, shock index, platelet count, placental separation percentage, and chronic hypertension/preeclampsia. The optimism-corrected area under the receiver operating characteristic curve (AUC) was 0.916, with calibration slope 0.96 and Brier score 0.12. DIC incidence was 2.9% in low-risk (0–4 points), 7.6% in moderate-risk (5–8 points), and 86.0% in high-risk (≥9 points) patients. Discrimination remained stable across complete-case (AUC 0.909), single-imputation (0.913), Firth-penalized (0.914), transfer-excluded (0.902), four-variable (0.892), reduced three-predictor (0.842, excluding fibrinogen and platelet count), pathology-confirmed subgroups (0.887) and composite clinical outcome (0.801) analyses, and exceeded that of the ISTH (0.812), Erez (0.848) and Kobayashi (0.793) comparator scores. Conclusions: The PAD Score offers a straightforward method for stratifying DIC risk in placental abruption. External validation in independent cohorts is needed before clinical implementation. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

► Show Figures

Graphical abstract

13 pages, 503 KB

Open AccessArticle

The Prognostic Value and Perioperative Dynamics of the HALP Score in Placenta Accreta Spectrum Surgeries

by Tuğçe Arslanoğlu, Sezin Uludağ, Oğuzhan Yürük, Hale Çetin Arslan, Pakize Özge Karkin, Seda Atak, Nuran Tamtürk, Serap Adıyaman, Deniz Kanber Açar and Alev Atış Aydın

J. Clin. Med. 2025, 14(21), 7781; https://doi.org/10.3390/jcm14217781 - 2 Nov 2025

Viewed by 664

Abstract

Objective: We aimed to evaluate the prognostic value of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in placenta accreta spectrum (PAS) surgeries and its perioperative dynamics as a marker of surgical and neonatal outcomes. Methods: This retrospective cohort included 100 patients with histopathologically confirmed PAS who underwent cesarean hysterectomy (2016–2025). The HALP was calculated within 24 h before delivery and reassessed at 6 and 24 h after delivery. Demographic, surgical, and neonatal variables were recorded. The primary outcome was the association between preoperative HALP and surgical morbidity; the secondary outcomes were perioperative HALP changes and neonatal correlations. ROC analysis identified cutoff values; multivariable regression was used to determine predictors of HALP variability. Internal validity was assessed via bootstrap resampling (1000 and 5000 iterations). Results: Preoperative HALP was significantly greater in patients with complications (24.14 vs. 22.58; p = 0.023). ROC analysis yielded a cutoff of 29.23, with 53.2% sensitivity and 82.0% specificity (AUC: 0.602, 95% CI: 0.51–0.69;). HALP showed a biphasic perioperative pattern, increasing at 6 h and then decreasing at 24 h (p < 0.001). Elevated HALP was independently associated with earlier gestational age at diagnosis, lower birthweight, and reduced Apgar scores. Bootstrap analyses revealed a stable AUC (~0.60) and consistent cutoff estimates across resamples. Conclusions: Higher HALP scores, which are typically markers of favorable nutritional status, are paradoxically linked to increased maternal morbidity and adverse neonatal outcomes in patients with PAS. HALP may, therefore, reflect placental invasiveness rather than maternal reserve. Its low cost and dynamic behavior highlight its potential utility in preoperative risk stratification for high-risk obstetrics. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

► Show Figures

Figure 1

14 pages, 398 KB

Open AccessArticle

Fetuin-A Concentration in the Perinatal Period and Maternal BMI Dynamics During Pregnancy, Labor, and Early Postpartum: Is ΔBMI a Parameter Worth Considering?

by Aleksandra Obuchowska-Standyło, Żaneta Kimber-Trojnar, Monika Czuba, Katarzyna Trojnar and Bożena Leszczyńska-Gorzelak

J. Clin. Med. 2025, 14(19), 6782; https://doi.org/10.3390/jcm14196782 - 25 Sep 2025

Viewed by 874

Abstract

Background/Objectives: Fetuin-A is a multifunctional glycoprotein involved in metabolic and inflammatory regulation. Although its role in insulin resistance, type 2 diabetes, and cardiovascular disease is well recognized, its relationship with pregnancy-related body mass changes remains unclear. This study aimed to explore associations between maternal BMI dynamics during and shortly after pregnancy and serum fetuin-A concentrations. Methods: Fifty-five healthy Caucasian women with term singleton pregnancies were enrolled. BMI was recorded at three time points: pre-pregnancy, before delivery, and 48 h postpartum. Based on ΔBMI (postpartum minus pre-pregnancy BMI), participants were divided into two groups: ΔBMI ≤ 1 kg/m² (n = 32) and ΔBMI > 1 kg/m² (n = 23). Serum fetuin-A levels were measured before delivery and postpartum using ELISA. Additional laboratory parameters and body composition were assessed postpartum via standard tests and bioelectrical impedance analysis (BIA). Results: No significant differences were found between groups in BMI at any single time point or in laboratory or BIA-derived parameters. However, all three BMI change indices (ΔBMI_gestational, ΔBMI_puerperal, and ΔBMI) differed significantly between groups. Fetuin-A concentrations did not differ significantly between groups. Importantly, fetuin-A levels decreased significantly after delivery in both groups, suggesting a potential role of the placenta in its regulation. A significant correlation was observed between pre-delivery fetuin-A and postpartum uric acid in Group ΔBMI > 1 kg/m² (p = 0.016), indicating a possible link in women with greater gestational weight gain. Conclusions: While fetuin-A was not directly associated with BMI changes, its peripartum dynamics and correlation with uric acid may reflect underlying metabolic-inflammation pathways. ΔBMI indices may offer a more individualized measure of weight dynamics in pregnancy research. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

► Show Figures

Figure 1

Review

Jump to: Research, Other

12 pages, 1211 KB

Open AccessReview

Rethinking the Postpartum “Orphan Window” Treatment in Gestational Diabetes Management

by Angelo Sirico, Lucia Sandullo, Maria Fatigati, Davide Pisani, Giuseppe Maria Maruotti and Luigi Cobellis

J. Clin. Med. 2026, 15(7), 2519; https://doi.org/10.3390/jcm15072519 - 26 Mar 2026

Viewed by 716

Abstract

Gestational Diabetes Mellitus (GDM) is the most common metabolic complication of pregnancy, affecting approximately 14% of pregnancies globally. Despite the frequent normalization of glycemic parameters immediately after delivery, GDM is an important precursor of subsequent chronic disease, increasing the risk of type 2 diabetes (T2DM). Current international guidelines suggest just a strictly observational approach during the immediate puerperium, recommending metabolic screening only between 6 and 12 weeks postpartum. This has contributed to the creation of a therapeutic “orphan window” where women receive no specific metabolic support, leaving their metabolic status unassessed and unmanaged. We postulate that the immediate postpartum period represents a critical window of “metabolic plasticity” where the abrupt cessation of placental hormones offers a unique opportunity to restore insulin sensitivity and promote “beta-cell rest” before the onset of irreversible dysfunction. Consequently, this narrative review and perspective examines the epidemiological urgency of the GDM-to-T2DM transition and provides a biological rationale for early pharmacological or nutraceutical intervention. Specifically, we discuss the limitations of metformin and present the hypothesis of myo-inositol combined with alpha-lactalbumin as a safe, lactation-compatible “bridging therapy” to preserve beta-cell function, improve compliance, and modify the natural history of diabetes in this high-risk population, highlighting that this theoretical proposal requires validation through future clinical trials. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

► Show Figures

Figure 1

Other

Jump to: Research, Review

18 pages, 2151 KB

Open AccessSystematic Review

Clinical Scores of Peripartum Patients Admitted to Maternity Wards Compared to the ICU: A Systematic Review and Meta-Analysis

by Jennifer A. Walker, Natalie Jackson, Sudha Ramakrishnan, Claire Perry, Anandita Gaur, Anna Shaw, Saad Pirzada and Quincy K. Tran

J. Clin. Med. 2025, 14(14), 5113; https://doi.org/10.3390/jcm14145113 - 18 Jul 2025

Viewed by 2325

Abstract

Background/Objectives: Hospitalized peripartum patients who later decompensate and require an upgrade to the intensive care unit (ICU) may have an increased risk for poor outcomes. Most of the literature regarding the need for ICU involves Modified Early Warning Scores in already hospitalized patients or the evaluation of specific comorbid conditions or diagnoses. This systematic review and meta-analysis aimed to assess the differences in clinical scores at admission among adult peripartum patients to identify the later need for ICU. Methods: We systematically searched Ovid-Medline, PubMed, EMBASE, Web of Science and Google Scholar for randomized and observational studies of adult patients ≥18 years of age who were ≥20 weeks pregnant or up to 40 days post-partum, were admitted to the wards from the emergency department and later required critical care services. The primary outcome was the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included other clinical scores, the hospital length of stay (HLOS) and mortality. The Newcastle–Ottawa Scale was utilized to grade quality. Descriptive analyses were performed to report demographic data, with means (±standard deviation [SD]) for continuous data and percentages for categorical data. Random-effects meta-analyses were performed for all outcomes when at least two studies reported a common outcome. Results: Seven studies met the criteria, with a total of 1813 peripartum patients. The mean age was 27.2 (±2.36). Patients with ICU upgrades were associated with larger differences in mean SOFA scores. The pooled difference in means was 2.76 (95% CI 1.07–4.46, p < 0.001). There were statistically significant increases in Sepsis in Obstetrics Scores, APACHE II scores, and HLOS in ICU upgrade patients. There was a non-significantly increased risk of mortality in ICU upgrade patients. There was high overall heterogeneity between patient characteristics and management in our included studies. Conclusions: This systematic review and meta-analysis demonstrated higher SOFA or other physiologic scores in ICU upgrade patients compared to those who remained on the wards. ICU upgrade patients were also associated with a longer HLOS and higher mortality compared with control patients. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

► Show Figures

Journal Menu

Journal Browser

Pregnancy Complications and Maternal-Perinatal Outcomes

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (5 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI