Search Results (191)

Background: Maternal postpartum hospital readmissions represent profound implications for maternal health outcomes and potential gaps in quality of maternal care. Objective: This study aims to synthesise evidence on risk factors for maternal postpartum hospital readmissions within 42 days of discharge following birth hospitalisation. Methods: An electronic database search utilised CINAHL, EMBASE (Ovid), and MEDLINE for relevant studies published from 1 January 2010 to 30 June 2024. The studies that investigated the prevalence and risk factors for 42-day postpartum maternal readmission and reported risk estimates, published in English, were included. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) for case-control studies and cohort studies. The PRISMA guidelines were followed in reporting this review. The review protocol was registered on PROSPERO (CRD42023442269). Results: A total of 7758 articles were retrieved, ultimately including 60 studies. The rate of maternal postpartum readmissions varied from 0.1236‰ to 26%. Significant risk factors were extracted and categorised into five groups: maternal demographic and socio-economic factors; behavioural and lifestyle factors; health institution structural factors; obstetric and delivery characteristics; as well as maternal morbidity The most frequently cited risk factors which contributed to maternal postpartum hospital readmissions were age, race/ethnicity, substance use, caesarean delivery, length of maternal hospital stay, premature birth, and all maternal morbidities, especially mental health disorders, severe maternal morbidity, and hypertensive disorders of pregnancy. Conclusions: This systematic review identified complex and diverse risk factors associated with maternal postpartum hospital readmissions within 42 days after discharge following birth hospitalisation. This helps our understanding of the risk factors and the strength of association with maternal postpartum hospital readmissions. Future research should develop a multidimensional risk assessment framework to guide clinical practice in adopting holistic individualised approaches for postpartum risk evaluation, thereby reducing readmission rates and improving maternal health outcomes. Full article

Background: During the COVID pandemic increased rates of intensive care unit (ICU) admission, mechanical ventilation, caesarean delivery, and preterm birth among women with SARS-CoV-2 infection in pregnancy were recorded. Purpose: This study describes the clinical course and perinatal outcomes of pregnant women with COVID-19 across pre- and post-vaccination periods. Methods: This study included all pregnant women with confirmed SARS-CoV-2 infection who subsequently delivered at the University General Hospital of Larissa between March 2020 and May 2023. Demographics, comorbidities, gestational age at infection and at delivery, COVID-19 symptoms, need for hospitalization, obstetric complications, mode of delivery, and neonatal outcomes were documented. An assessment of ischemia-modified albumin (IMA) was performed in a subset of women. Results: A total of 327 women (including 14 twin gestations) were recorded. Most women experienced mild disease while a minority required hospital admission, or intensive care (1.8 and 0.3% for the studied population, respectively). Fever and upper respiratory symptoms predominated, while radiologic evidence of pneumonia was rare. Overall preterm birth (<37 weeks) occurred in 13% of pregnancies and caesarean section in about two thirds of deliveries. Neonatal outcomes were favorable, with low rates of neonatal intensive care unit (NICU) admission and no early neonatal deaths. IMA values were higher during acute infection and declined towards recovery. Conclusion: Pregnant women with COVID-19 in Central Greece had predominantly mild clinical courses and excellent perinatal outcomes. IMA may represent a biologically plausible marker of disease activity, but further studies are needed. Full article

Background: Foreign citizenship and low socioeconomic status are key determinants of health inequalities and may influence maternal and neonatal outcomes. This study aimed to assess maternal health during pregnancy and the main adverse maternal and neonatal outcomes related to labour and childbirth among women living in Trentino (Northern Italy), comparing women with Italian and foreign citizenship. Methods: A retrospective epidemiological study was conducted using data from the Birth Assistance Certificate (CedAP) database of the Autonomous Province of Trento. This study included all women who gave birth in Trentino between 2012 and 2016. Associations between citizenship and adverse outcomes were assessed using multivariable logistic regression models adjusted for potential confounders. Results: The analysis included 23,165 women, of whom 25.9% had foreign citizenship. Women with foreign citizenship showed a significantly higher risk of gestational diabetes mellitus compared with Italian women and an increased risk of extremely preterm birth (<28 weeks of gestation), particularly among women from Central and South America, Asia and Eastern Europe. Regarding labour and mode of delivery, women with foreign citizenship had a higher risk of caesarean section, especially among women from Central and South America and Africa. In terms of neonatal outcomes, infants born to women with foreign citizenship showed a higher likelihood of requiring phototherapy and admission to the neonatal intensive care unit. Conclusions: Significant differences were observed between immigrant and Italian women in both social determinants and maternal and neonatal perinatal outcomes. Identifying factors associated with adverse outcomes during pregnancy may help improve targeted maternal care and reduce health inequalities for both mothers and newborns. Full article

Background/Objective: The primary aim of this study was to establish a clinically relevant cut-off for detecting postpartum anaemia using non-invasive haemoglobin measurement, and to compare the non-invasive method with laboratory haemoglobin testing. This study was conducted as a prospective observational study at a single centre. Pregnant women giving birth vaginally or by caesarean birth at a university hospital were included in this study. Methods: We measured haemoglobin by non-invasive and laboratory means at delivery room discharge and after childbirth in the operation room. We then calculated a clinically relevant cut-off for detecting postpartum anaemia using the non-invasive measurement method. The main outcomes were the invasively and non-invasively measurements of haemoglobin and the correlation between the two measurements. Results: In total, 466 complete measurement pairs from 323 women were included, and 179 (38.4%) laboratory measurements were found to be anaemic (haemoglobin value < 11 g dL⁻¹). Maximising specificity while maintaining a minimum sensitivity of 80%, we identified a cut-off of 13.75 g dL⁻¹, which achieved a sensitivity of 81.0% and a specificity of 54.7%. The NPV at this threshold was 82.2%, while the PPV was 52.7%. The mean difference between measurements was found to be +2.3 g dL⁻¹ (CI 95% 2.16 to 2.43). Conclusions: Non-invasive haemoglobin measurement did not sufficiently detect anaemia compared to laboratory measurement values in the setting of early postpartum women, even after adjusting for bias. However, the proposed cut-off could potentially aid healthcare providers in low-resource situations. Full article

Background: Extremely low birth weight (ELBW) neonates (<1000 g) contribute significantly to global neonatal and under-five mortality, with heightened vulnerability in resource-limited settings. Objectives: The overall aim of this manuscript is to evaluate the survival outcomes and associated factors among ELBW infants in a resource-limited tertiary care setting in South Africa. Methods: This retrospective cohort study examined survival outcomes, causes of death, and associated morbidities among 192 ELBW infants admitted to Frere Hospital, South Africa (SA), between January 2020 and February 2025. Kaplan–Meier survival analysis and multivariable Poisson regression were used to identify predictors of mortality. Results: Overall, 42% of neonates survived to discharge. Common morbidities included respiratory distress syndrome (78%) and extreme prematurity (30%). Extreme prematurity (<28 weeks) was associated with a markedly increased risk of mortality (adjusted IRR = 0.20; 95% CI: 0.08–0.53; p < 0.001), while caesarean section conferred a protective effect compared to vaginal delivery (adjusted IRR = 0.38; 95% CI: 0.23–0.64; p < 0.001). Conclusions: The findings highlight that strengthened antenatal care, consistent neonatal resuscitation, and equitable intensive care remain essential. Policy-driven investment in surfactant therapy, CPAP, and infection control is critical; without such measures, ELBW infants’ mortality will continue to be disproportionately high in resource-limited settings. Full article

Background: Early childhood growth trajectories can influence the risk of chronic diseases in adulthood. Improvements in environmental sanitation may affect child development in low-resource settings. Objective: to examine the associations among socioeconomic factors with nutrition indicators, and trajectories of anthropometric indicators across three epidemiological cohorts that reflect different phases of environmental sanitation implementation. Methods: A longitudinal study was conducted in Salvador, Brazil, from 1997 to 2013. A total of 1429 children were recruited across three epidemiological cohorts, corresponding to the phases of a sanitation program: pre-intervention (n = 299), intervention (n = 1007), and post-intervention (n = 123). Height-for-age (HAZ) and BMI-for-age (BAZ) z-scores were assessed at four time points. Multilevel linear models were used to adjust for socioeconomic factors. Results: A total of 992 children (68.7%) completed follow-up. Post-intervention children showed improved HAZ trajectories, with sex-specific patterns that varied across cohorts. Birth weight is positively associated with HAZ across all cohorts (0.34–0.49 kg increase per z-score). Household overcrowding (>2 persons/room) is consistently associated with lower HAZ (−0.34 to −0.63 z-score reduction). Children who were never exclusively breastfed in the post-intervention phase had a higher BAZ (0.76 z-score increase). Caesarean delivery is associated with higher BAZ in the pre-intervention (0.23) and intervention (0.27) cohorts. Conclusions: Children born in later time periods showed better growth trajectories, which may reflect the combined effects of sanitation improvements, economic development, and other societal changes in Brazil during this period. Further research using experimental or quasi-experimental designs is needed to isolate the specific contribution of sanitation to child growth. Full article

Background/Objectives: Preterm birth remains a major cause of neonatal morbidity and mortality, particularly in multiple pregnancies and in cases of cervical shortening. While cervical cerclage is established in singleton pregnancies, its efficacy in multiple gestations remains uncertain. This study compares pregnancy and neonatal outcomes following second-trimester cerclage in singleton and multiple pregnancies with a short cervix. Methods: In this retrospective cohort study, 96 women underwent second-trimester cerclage at a tertiary perinatal center between 2020 and 2024. All had a cervical length ≤ 25 mm or prolapsed membranes without infection or premature rupture. Primary outcomes included term delivery rate, gestational age, mode of delivery, and neonatal outcomes; secondary outcomes comprised surgical complications and rehospitalization, defined as the need for renewed inpatient care due to threatened preterm labor or procedure-related complications. Results: In total, 79 singleton and 17 multiple pregnancies were analyzed. Term delivery occurred more often in singletons (54%) than multiples (18%, p = 0.006). Mean gestational age at birth was 258 ± 25 days in singletons versus 228 ± 28 days in multiples (p < 0.001). Birth weight was significantly lower in multiples (1985 g vs. 2943 g; p < 0.001), and neonatal infections were more frequent (53% vs. 26%; p = 0.008). Caesarean delivery was more common in multiples (82% vs. 33%; p < 0.001). Apart from increased postoperative contractions in multiples (24% vs. 5%; p = 0.031), complication rates and rehospitalization (27% vs. 29%; p = 0.8) were similar. Conclusions: Second-trimester cerclage is less effective in preventing preterm birth in multiple pregnancies compared to singleton pregnancies; however, it appears to be associated with a stabilizing clinical course and may facilitate outpatient management in selected high-risk cases. These findings support individualized counseling and shared decision-making, particularly in multifetal gestations. Full article

Background/aim: Despite the fact that qualitative research on postpartum depression (PPD) has been extensively researched globally, women’s perceptions of PPD misconceptions are mostly ignored in developing countries like Jordan. Thus, this study aims to explore Jordanian women’s sociocultural perceptions and misconceptions about PPD using the descriptive phenomenological design. Methods: Fourteen women who had either a normal or caesarean (C-section) delivery and resided in Irbid, Northern Jordan, participated in semi-structured in-depth interviews, which lasted 15 to 25 min in May 2025. Data were gathered via field note transcriptions of interviews, and analysis followed Colaizzi’s data analysis methodology. Results: Among participants, five women (all C-section deliveries) reported a PPD diagnosis, while the remaining normal delivery women reported experiencing depression before giving birth. The women’s sociocultural perceptions and misconceptions about PPD were found to be reflected in a number of themes. The theme “perceiving PPD as normal baby blues” captures the general lack of awareness regarding this disorder. Three important themes—“myths”, “psychological”, and “spiritual and religious failure”—show how little is known about the causes. The two primary themes that are impacted by sociocultural perspectives are “stigma” and “mistrust of professional care services”. The accuracy and misconceptions around this disorder are summed up in four basic themes: “emotional misconceptions”, “cultural misconceptions”, “false beliefs about health”, and “think of PPD as indolence”. Conclusions: Jordanian women have limited understanding and misconceptions of PPD. Adopting culturally relevant awareness campaigns is essential to disseminating the knowledge required to facilitate improved treatment pathways. Full article

Introduction: Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. While antifibrinolytic agents such as tranexamic acid are effective in treating established postpartum hemorrhage, the benefit of prophylactic tranexamic acid remains debated. The presence and frequency of early postpartum hyperfibrinolysis during routine childbirth have not been thoroughly investigated. Material & Methods: This prospective observational study was registered on ClinicalTrials.gov (NCT05975112) and conducted at the Medical University Hospital Graz between June 2023 and June 2024. Blood samples were collected from 413 women immediately after umbilical cord clamping; 379 were included in the analysis—291 undergoing Caesarean section and 88 vaginal delivery. Hyperfibrinolysis was assessed using thromboelastography and defined as an LY30 value > 8%. Additional coagulation parameters—including fibrinogen, D-dimer, activated partial thromboplastin time, and prothrombin time—were measured. Correlation analyses between viscoelastic and conventional parameters were performed using Pearson’s correlation coefficients. Results: No cases of clinically significant hyperfibrinolysis (LY30 > 8%) were observed. However, 15.5% of women showed elevated LY30 values (>0%). LY30 values were significantly higher in vaginal deliveries compared to Caesarean sections (p = 0.003). A moderate correlation between maximum amplitude (MA) and fibrinogen was observed (r = 0.52), strongest in vaginal deliveries (r = 0.65). Other correlations were weak or negligible. Conclusions: Clinically relevant hyperfibrinolysis was not observed immediately postpartum in women without hemorrhage. These findings are consistent with current guidelines recommending tranexamic acid for therapeutic rather than routine prophylactic use. Viscoelastic testing may be useful for rapid assessment in early-stage bleeding. Further research should explore fibrinolytic activity later in the postpartum period. Full article

The reduced scattering coefficient (μ_s′), measured using time-resolved near-infrared spectroscopy (TR-NIRS) has been linked to brain water diffusion assessed by diffusion tensor imaging, suggesting its potential as a bedside marker of cerebral microstructure. However, the physiological determinants of μ_s′ and its early postnatal changes remain unclear. This study examined clinical associations with cerebral μ_s′ in healthy term newborn infants during the first 2 postnatal days. Eighteen newborn infants underwent TR-NIRS at 6 and 36 h postnatally. Associations between μ_s′ and 14 clinical variables were analysed using generalised estimating equations. Median μ_s′ was 7.395 cm⁻¹ (IQR: 6.140–8.159) at 6 h and 7.112 cm⁻¹ (IQR: 6.473–7.410) at 36 h, with no significant difference (p = 0.327). Male sex was associated with higher μ_s′ (regression coefficient = 0.895, p = 0.007), whereas caesarean delivery (regression coefficient = −0.969, p = 0.012) was associated with lower μ_s′. A significant interaction between caesarean delivery and postnatal age indicated that the negative effect diminished between 6 and 36 h after birth (difference = 0.057, p = 0.016). These findings suggest delivery mode transiently influences brain scattering, whereas the effect of sex remains stable, supporting further investigation of TR-NIRS as an acute-phase cerebral marker. Full article

Background/Objectives: Childbirth, although generally a positive life event, can sometimes be experienced as traumatic, leading to postpartum post-traumatic stress disorder. Emergency caesarean section and operative vaginal delivery are associated with elevated psychological distress, while factors such as lifetime trauma, domestic violence, anxiety, and coping strategies may further increase vulnerability. Methods: This prospective cohort study included 113 postpartum women who delivered via emergency caesarean section (73.5%) or operative vaginal delivery (26.5%) in two tertiary hospitals in Athens, Greece (March–July 2023). Data were collected at three time points: the second postpartum day, six weeks postpartum, and three months postpartum. Descriptive statistics were used to summarize sample characteristics. Chi-square tests were performed for categorical variables and independent sample t-tests for continuous variables. Multivariate logistic regression analyses were conducted to identify predictors of postpartum post-traumatic stress disorder, with results expressed as odds ratios (OR) and 95% confidence intervals (CI). Results: At six weeks postpartum, 14.2% of participants met full diagnostic criteria for P-PTSD. Postpartum post-traumatic stress was strongly associated with higher state and trait anxiety, fewer positive coping strategies, and exposure to domestic violence (lifetime, during pregnancy, and in the past year). Women with traumatic childbirth experiences had a 14.7-fold higher risk of developing P-PTSD. Lifetime trauma, particularly physical or sexual abuse and exposure to disasters, further increased vulnerability. Over the last three months, 50% of those initially diagnosed continued to meet the diagnostic criteria. Multivariate analysis identified traumatic childbirth, state anxiety, and domestic violence during pregnancy as significant predictors of postpartum post-traumatic stress. Conclusions: Postpartum post-traumatic stress is a significant and underestimated consequence of high-risk deliveries. Screening for domestic violence and trauma history during pregnancy, assessing perinatal anxiety, and providing trauma-informed psychological support are critical to reducing maternal psychiatric morbidity and promoting maternal-infant well-being. Full article

(1) Background: While the Robson Ten-Group Classification System (RTGCS) is widely used to assess and monitor caesarean section rates, its association with exclusive breastfeeding (EBF) outcomes at hospital discharge remains insufficiently explored. This study aimed to examine differences in EBF rates at hospital discharge across RTGCS groups among births attended at Hospital Universitario de la Ribera (Spain). (2) Methods: This retrospective observational study was conducted at a public hospital between 1 January 2010 and 31 December 2023. EBF at hospital discharge was analysed across Robson groups. Sociodemographic, obstetric, and neonatal variables were collected. A binomial logistic regression model was developed to identify predictors of EBF at discharge. Model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test and Nagelkerke’s R². (3) Results: The study analysed 23,081 births classified using the RTGCS, and 23,037 were included in the breastfeeding analysis. The overall EBF rate at discharge was 74.10%, with significant variation across Robson groups. Group 1 showed the highest EBF rate (78.339%) whereas Group 8 had the lowest (56.485%). Key factors positively associated with EBF included non-Spanish origin, nulliparity, cephalic presentation, singleton pregnancy, and term gestation. (4) Conclusions: Group 1 demonstrated the highest EBF rates, whereas Groups 8, 5, and 7 exhibited the lowest. These findings are essential for informing the development of targeted support strategies to improve breastfeeding outcomes in high-risk populations. Full article

Preterm birth remains a significant global health challenge and is strongly associated with heightened risks of long-term neurodevelopmental impairments, including cognitive delays, behavioural disorders, and emotional dysregulation. In recent years, accumulating evidence has underscored the critical role of the gut microbiota in early brain development through the gut–brain axis. In preterm infants, microbial colonisation is frequently delayed or disrupted due to caesarean delivery, perinatal antibiotic exposure, formula feeding, and prolonged stays in neonatal intensive care units (NICUs), all of which contribute to gut dysbiosis during critical periods of neurodevelopment. This review synthesises current knowledge on the sources, temporal patterns, and determinants of gut microbiota colonisation in preterm infants. This review focuses on the gut bacteriome and uses faecal-sample bacteriome sequencing as its primary method of characterisation. We detail five mechanistic pathways that link microbial disturbances to adverse neurodevelopmental outcomes: immune activation and white matter injury, short-chain fatty acids (SCFAs)-mediated neuroprotection, tryptophan–serotonin metabolic signalling, hypothalamic–pituitary–adrenal (HPA) axis modulation, and the integrity of intestinal and blood–brain barriers (BBB). We also critically examine emerging microbiota-targeted interventions—including probiotics, prebiotics, human milk oligosaccharides (HMOs), antibiotic stewardship strategies, skin-to-skin contact (SSC), and faecal microbiota transplantation (FMT)—focusing on their mechanisms of action, translational potential, and associated ethical concerns. Finally, we identify key research gaps, including the scarcity of longitudinal studies, limited functional modelling, and the absence of standardised protocols across clinical settings. A comprehensive understanding of microbial–neurodevelopmental interactions may provide a foundation for the development of targeted, timing-sensitive, and ethically sound interventions aimed at improving neurodevelopmental outcomes in this vulnerable population. Full article

Over the past two decades, pregnancy and birth trends have undergone significant shifts across Australia, the United States of America (USA), and the United Kingdom (UK), reflecting changes in societal norms, healthcare advancements, and demographic patterns. Variations in maternal age, birth interventions, and fertility rates highlight the evolving nature of reproductive behaviors and healthcare systems in these nations. The analysis reveals consistent increases in maternal age and gestational diabetes, alongside rising caesarean section rates—particularly in private healthcare settings. While perinatal mortality has declined overall, maternal mortality has increased in the USA and remains disproportionately high among Indigenous women and those in ethnic minorities in all three countries. These findings highlight the influence of structural inequities, healthcare access, and policy differences in maternal health. The review underscores the urgent need for equity-focused, culturally safe, and system-level interventions, as well as improved data collection and international collaboration to reduce preventable maternal and neonatal harms. By comparing these three regions, this review aims to provide insights into the shared challenges and unique approaches shaping childbirth practices in high-income countries in the 21st century. Full article

Background/Objectives: Adolescent pregnancies are associated with negative outcomes of health and social and economic consequences for both the mother and child. The aim of this audit was to determine the incidence of gynaecological complications and adverse social determinants of health affecting pregnant women less than 20 years old at the time of delivery in Stoke-on-Trent, with the goal of improving local and national trust guidelines. Methods: A retrospective case note review was conducted using electronic databases. Subjects had to be under the age of 20 years old at the time of delivery at our local tertiary hospital from January 2020 to December 2022. Results: Four hundred and seventy-three women met the inclusion criteria. The median age was 18 years old (range: 13–19 years). Most women delivered at term (mean 38⁺³), were primigravida (76%), and underwent spontaneous delivery (43%). Both our induction rate of 28.2% and caesarean section rate of 18.4% were below the national averages. Complications of post-partum haemorrhage and low birth weights exceeded the national averages, with third- to fourth-degree perineal tears just below the national incidence rate of 2.9%. Negative social determinants of health included smoking, mental illness, and low breastfeeding rates. Our mean 3-year breastfeeding rate was 24.3%. Conclusions: This single-centre audit at a large tertiary hospital has demonstrated that women under the age of 20 years old in socially deprived areas of the UK are more likely to experience negative gynaecological and social outcomes from their pregnancies compared to areas of low deprivation within the UK. Full article