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Clinical Challenges in High-Risk Pregnancy and Delivery

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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: closed (30 October 2025) | Viewed by 10227

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Special Issue Editor

Dr. Salvatore Andrea Mastrolia

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Guest Editor

Department of Obstetrics and Gynecology, Ospedale Madonna delle Grazie, Matera, Italy
Interests: great obstetrical syndromes; IUGR; pre-eclampsia; placental abruption; fetal demise; pPROM; gestational diabetes; recurrent abortion
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Special Issue Information

Dear Colleagues,

High-risk pregnancies present numerous clinical challenges that require careful management and monitoring. Key factors leading to high-risk pregnancies include maternal age, pre-existing medical conditions (such as hypertension or diabetes), multiple gestation, and pathological conditions included within the great obstetrical syndromes (preterm labor, preterm PROM, fetal demise, placental abruption, pre-eclampsia, IUGR). Early identification and adequate monitoring are critical for managing these risk factors and syndromes. In such cases, obstetricians must balance the health of both the mother and the fetus, often involving a multidisciplinary team. These pregnancies generate several issues regarding labor and delivery due to the fact that the placenta, in these fetuses, may be affected by different levels of malfunction. Timely interventions, such as administering corticosteroids to accelerate fetal lung maturity or controlling maternal blood pressure, can improve maternal outcomes, but only if diagnosis occurs as early as possible. High-risk pregnancies also require post-delivery care, as complications, such as hemorrhage or infection, are more likely. Therefore, effective management hinges on timely intervention, close surveillance, and coordinated care, making collaboration among specialists in maternal–fetal medicine, anesthesiology, and neonatology crucial.

Dr. Salvatore Andrea Mastrolia
Guest Editor

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Keywords

high-risk pregnancy
preeclampsia
cesarean section
maternal–fetal medicine
ultrasound
fetal monitoring
complications
delivery
placental abruption
great obstetrical syndromes

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Published Papers (4 papers)

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Research

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16 pages, 276 KB

Open AccessArticle

Associations of Mentally Active and Passive Sedentary Behavior with Sleep Quality and Duration in Pregnant Women of Advanced Versus Younger Maternal Age

by Abdullah Bandar Alansare

J. Clin. Med. 2025, 14(24), 8666; https://doi.org/10.3390/jcm14248666 - 7 Dec 2025

Viewed by 221

Abstract

Background/Objectives: To examine associations of mentally active and passive sedentary behavior (SB) with sleep quality and duration in pregnant women of advanced (AMA) and younger (YMA) maternal age, separately, and evaluate effects of SB patterns (weekends vs. weekdays). Methods: This secondary analysis of an observational, clinic-based, cross-sectional study included pregnant women of AMA (n = 225; 37.8 ± 2.6 years) and YMA (n = 710; 27.5 ± 3.8 years) from any trimester. SB and sleep were assessed using the Arabic version of the Sedentary Behavior Questionnaire and the Pittsburgh Sleep Quality Index, respectively. Logistic regression models evaluated associations of maternal mental activity-based SB with sleep outcomes. Results: Higher mentally passive SB on weekdays was unfavorably associated (odds ratios ranged between 1.58 and 2.12; p < 0.05 for all), and on weekends was paradoxically and favorably associated (odds ratios ranged between 0.53 and 0.62; p < 0.05 for all) with sleep quality only in pregnant women of AMA. Higher mentally passive SB across the week or on weekdays was unfavorably associated (odds ratios ranged between 1.11 and 1.65; p < 0.05 for all), while higher mentally passive SB on weekends and mentally active SB across the week or on weekends were paradoxically and favorably associated (odds ratios ranged between 0.57 and 0.91; p < 0.05 for all) with a higher adherence to sleep duration recommendations in both pregnancy groups. Conclusions: These findings suggest that some relationships between mental activity-based SB and prenatal sleep health may vary across maternal age groups. The cross-sectional design limits causal inference, emphasizing the need for longitudinal and randomized studies on mental activity-based SB and sleep health in pregnant women of AMA and YMA. Full article

(This article belongs to the Special Issue Clinical Challenges in High-Risk Pregnancy and Delivery)

14 pages, 609 KB

Open AccessArticle

First- and Second-Trimester Uterine Artery Doppler and Hypertensive Disorders in Twin Pregnancies

by Stephanie Springer, Teresa Anzböck, Katharina Worda, Eva Karner and Christof Worda

J. Clin. Med. 2025, 14(15), 5563; https://doi.org/10.3390/jcm14155563 - 7 Aug 2025

Viewed by 1641

Abstract

Objective: The objective of this study is the investigation of uterine artery Doppler studies in twin pregnancies. Methods: This retrospective cohort study included 554 twin pregnancies. All women underwent measurement using the mean uterine artery pulsatility index (UTPI) in gestational weeks 11⁺⁰–13⁺⁶ and 19⁺⁰–22⁺⁶ for risk assessment regarding the occurrence of preeclampsia and adverse obstetric outcomes. Results: Out of the 554 included women, a total of 51 women (9.2%) developed preeclampsia: 12 women (2.2%) developed early preeclampsia and 39 patients (7.0%) developed late preeclampsia. Adverse pregnancy outcomes occurred in 147 women (26.5%). The optimum cut-off for the mean UTPI to predict preeclampsia was calculated for gestational weeks 11⁺⁰–13⁺⁶ (UTPI > 1.682) and 19⁺⁰–22⁺⁶ (UTPI > 1.187). Between gestational weeks 11⁺⁰ and 13⁺⁶, the risk of developing preeclampsia was approximately 1.5 times higher when the mean UTPI was above the established cut-off. The risk of early preeclampsia increased 2.5-fold, and that of adverse pregnancy outcomes increased 1.5-fold. At 19⁺⁰ to 22⁺⁶ weeks, the preeclampsia risk doubled when the mean UTPI exceeded the cut-off. The risk increased 4-fold for early preeclampsia and 1.5-fold for adverse pregnancy outcomes. Regression analyses revealed that a mean UTPI above the set cut-off at both time points was significantly associated with preeclampsia, early preeclampsia, and adverse pregnancy outcomes. Conclusions: The best prediction for early preeclampsia can be achieved using a two-tailed screening approach that combines mean UTPI measurements taken at gestational weeks 11⁺⁰–13⁺⁶ and 19⁺⁰–22⁺⁶. Full article

(This article belongs to the Special Issue Clinical Challenges in High-Risk Pregnancy and Delivery)

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Review

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21 pages, 916 KB

Open AccessReview

Spectrum of Cervical Insufficiency: Management Strategies from Asymptomatic Shortening to Emergent Membrane Prolapse

by Dimitris Baroutis, Eleni Katsianou, Ioannis Fragiskos, Maria-Eleni Papakonstantinou, Konstantinos Koukoumpanis, Aikaterini-Gavriela Giannakaki, Alexander A. Tzanis, Vasilios Pergialiotis, Michael Sindos and George Daskalakis

J. Clin. Med. 2025, 14(23), 8506; https://doi.org/10.3390/jcm14238506 - 30 Nov 2025

Viewed by 823

Abstract

Background/Objectives: Cervical insufficiency affects 1–2% of pregnancies and represents a significant cause of second-trimester loss and spontaneous preterm birth. This review synthesizes current evidence across the clinical spectrum of cervical insufficiency, providing evidence-based management guidance and identifying areas requiring further investigation. Methods: We conducted a comprehensive review of the current literature, evidence-based clinical guidelines, and landmark randomized controlled trials examining diagnostic frameworks, therapeutic interventions, and clinical outcomes across different presentations of cervical insufficiency. Our analysis incorporated data from major obstetric databases, professional society recommendations, and recent comparative effectiveness research. Results: Cervical insufficiency diagnosis encompasses three primary categories: history-based, ultrasound-based, and physical examination-based. Vaginal progesterone achieves a 31% reduction in preterm birth before 33 weeks (RR 0.69, 95% CI 0.55–0.88; NNT= 14). Ultrasound-indicated cerclage achieves a 30% relative risk reduction for delivery <35 weeks. The landmark SuPPoRT trial (n = 386) demonstrated no statistically significant differences among cerclage, pessary, and progesterone (p = 0.4), though formal equivalence trials have not been conducted. Multiple gestations show no benefit from singleton-derived interventions (RR 0.99–1.04). Conclusions: Optimal cervical insufficiency management emphasizes individualized approaches based on comprehensive risk stratification and objective cervical assessment, with vaginal progesterone and cervical cerclage serving as cornerstone therapies supported by robust clinical evidence. Full article

(This article belongs to the Special Issue Clinical Challenges in High-Risk Pregnancy and Delivery)

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13 pages, 714 KB

Open AccessReview

Practical Considerations Concerning Preeclampsia Subgroups

by Peter Tamas, Balint Farkas and Jozsef Betlehem

J. Clin. Med. 2025, 14(7), 2498; https://doi.org/10.3390/jcm14072498 - 6 Apr 2025

Cited by 1 | Viewed by 7062

Abstract

Preeclampsia is one of the most serious clinical syndromes which can occur during pregnancy. According to our current knowledge, preeclampsia cannot be cured. However, a significant step forward is the recognizing preeclampsia is not a homogenous syndrome, i.e., different pathological events can lead to the hypertension + symptoms of organ damage, occurring in the second half of pregnancy. Clinically, two kinds of preeclampsia can be distinguished. The “classic” placental preeclampsia of immunological origin is characterized by contracted blood volume, fetal growth restriction, and marked alterations in laboratory indices. Patients in this subtype are characteristically young and primiparous. Clinical symptoms appear during the late second or early third trimester and show a quick progression. The outcome in cases of placental preeclampsia is frequently serious. For preventing the most critical conditions, the necessary delivery induction usually results in a preterm newborn. The maternal preeclampsia is associated with high blood volume. The characteristic augmented gestational weight gain is mostly a condition with a multifactorial background; however, obesity seems a critical risk factor. The early clinical symptoms are leg, and then generalized edema; hypertension and proteinuria appear after that. Laboratory abnormalities are rare; even platelet count remains within the normal range. The outcome is usually favorable; however, serious organ edema can lead to eclampsia or placental detachment. In the case of both types—from the name to the therapy—new data worthy of consideration have been created, which also justifies a change in attitude. Full article

(This article belongs to the Special Issue Clinical Challenges in High-Risk Pregnancy and Delivery)

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