Search Results (124)

Health crises hinder the provision of intensive care for critical obstetric conditions such as preeclampsia and eclampsia, where timely decision making and system capacity directly impact maternal and fetal outcomes. This study compared the clinical and epidemiological profile and care processes in the ICU for cases of preeclampsia and eclampsia before and during the COVID-19 health crisis in Alto Amazonas, Loreto (Peru), using a comparative mixed-method approach. Quantitative data were obtained from ICU medical records for two periods (2015–2019 and 2020–2022). Categorical variables were compared using exact methods (Fisher’s exact test for 2 × 2 tables and exact procedures for scatter tables with multiple categories), and continuous variables were compared using nonparametric tests where appropriate. The most notable change was an increase in the frequency of cesarean sections during the health crisis, which should be interpreted with caution given the small sample size and potential changes in admission criteria and system limitations. Other clinical indicators and discharge status showed no clear evidence of substantial differences between the periods. Qualitative findings highlighted systemic limitations affecting continuity of care, particularly those related to timely access to safe blood products and referral pathways. These results align with SDG 3 (Good Health and Well-being) and support strengthening preparedness, referral coordination, and the availability of essential resources to protect maternal health during large-scale emergencies. Full article

Objective: Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a rare but serious complication following cesarean section (CS). Identifying factors associated with its occurrence is critical for early recognition and prevention. This systematic review and meta-analysis aimed to synthesize available evidence on factors associated with ACPO following CS. Methods: We performed a systematic literature search across five databases (PubMed, Embase, CNKI, Wanfang, and CBM) from inception to December 2025. Studies investigating factors associated with ACPO after CS were eligible. Quality of included studies was assessed using the Newcastle–Ottawa Scale. For factors reported in at least two studies, pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. Results: Five case-control studies comprising 484 patients (103 ACPO cases and 381 controls) were included, of which four were rated as good quality. Twenty-five potential associated factors were analyzed. Several pre-/intraoperative factors demonstrated statistically significant associations with ACPO risk, including concomitant anemia (OR = 8.94, 95% CI: 2.59–30.88), previous abdominal surgery (OR = 2.39, 95% CI: 1.28–4.47), surgery duration > 1 h (OR = 4.11, 95% CI: 2.20–7.67), and blood loss > 1000 mL (OR = 5.72, 95% CI: 2.10–15.58). Intraoperative blood loss as a continuous variable (WMD = 1.30, 95% CI: 0.14–2.46) was also significantly associated with ACPO. In contrast, emergency cesarean section, opioid use, and type of anesthesia were not significantly associated. Regarding postoperative features, bed rest > 12 h (OR = 2.66, 95% CI: 1.29–5.49), postoperative fever ≥ 38 °C (OR = 3.82, 95% CI: 1.94–7.54), elevated postoperative white blood cell count (WMD = 1.22, 95% CI: 0.30–2.14), and lower postoperative hemoglobin level (WMD = −0.50, 95% CI: −0.83 to −0.18) were significantly associated with ACPO. However, these factors may represent consequences of perioperative complications or components of the early clinical presentation of ACPO. Conclusions: This systematic review and meta-analysis identified multiple perioperative factors associated with ACPO following CS. However, the use of univariate data from a limited number of studies limits interpretability. Prospective cohort studies are needed to clarify whether these factors play a causal role in the development of ACPO. Full article

Background: Value-based healthcare (VBHC) has emerged as a promising approach for improving quality while reducing costs. While evidence from tertiary hospitals suggests that outsourcing to VBHC networks can improve safety, efficiency, and satisfaction, less is known about its impact in low- and intermediate-complexity hospitals. The Madrid Regional Health System (RMHS), which stratifies hospitals by complexity, provides a unique opportunity to compare performance across management models. The objective of this study was to compare outcomes between low and intermediate-complexity hospitals outsourced to a VBHC network with those operating under public management and outsourced to traditional for-profit organizations. Methods: The researchers conducted a cross-sectional analysis using the RMHS 2024 annual audit report. Sixteen low- and intermediate-complexity hospitals were included: three outsourced to the VBHC network Quirónsalud and thirteen under public management and outsourced to a traditional private for-profit network. Monographic and long-term facilities were excluded. Variables included case mix complexity, quality and safety indicators (inpatient complications, hospital-acquired infections, low-risk cesarean sections), efficiency metrics (average and case-mix-adjusted length of stay), and patient satisfaction measures (survey scores and patient transfers under the Free Choice of Care Mandate). Continuous variables were compared using Mann–Whitney U tests and categorical variables with Chi-square tests. Results: Study hospitals managed more complex patients (median case-mix 1.06 vs. 0.88, p = 0.007). Despite this, no differences were found in complication rates. Hospital-acquired infections (3.47% vs. 5.46%, p < 0.001) and low-risk cesarean sections (16.1% vs. 19.3%, p < 0.001) were significantly lower in VBHC hospitals. Efficiency was improved, with shorter average length of stay (4.26 vs. 5.03 days, p = 0.031) and all study hospitals demonstrating lower-than-expected case-mix-adjusted stay, unlike several controls. Patient satisfaction was higher (0.91 vs. 0.87, p = 0.007), as were recommendation scores (0.96 vs. 0.92, p = 0.003). Patient transfers favored outsourced hospitals, with more patients choosing them and fewer leaving compared with controls. Conclusions: Low- and intermediate-complexity hospitals managed by a value-based network in Madrid achieved superior performance across safety, efficiency, and satisfaction indicators, despite treating more complex patients. These findings extend evidence for VBHC outsourcing beyond tertiary hospitals, highlighting potential for improved system-wide performance where universal coverage and hospital stratification ensure comparability. VBHC outsourcing may represent a viable strategy to enhance patient outcomes and optimize resource use in regional healthcare systems. Full article

The study aimed to determine whether placental lesions differ according to the duration of dystocia. Forty-seven placentas were obtained from 18 bitches that underwent emergency cesarean sections. For descriptive purposes, the cases were classified into four groups based on the duration of dystocia: Group A, up to 6 h; Group B, 6–11.9 h; Group C, 12–24 h; and Group D, more than 24 h. Forty-seven placentas were studied. Both macroscopic and microscopic characteristics were evaluated in each placenta. Descriptive data were presented, and logistic and multinomial regression models were used to assess whether dystocia duration (in hours) is associated with the presence and severity of placental macro- and microscopic lesions. An hour increment over the mean in the duration of dystocia showed a non-significant trend to increasing the presence of macroscopic necrosis (OR: 1.11, p = 0.09) and mineralization (OR: 1.10, p = 0.06), and it also increased the severity of macroscopic congestion (OR: 1.44; p = 0.01) and showed a non-significant trend to increasing the severity of polymorphonuclear neutrophil infiltrate (OR: 1.18; p = 0.06). These findings highlight the importance of early obstetric intervention in all cases of dystocia to minimize fetal hypoxia and improve neonatal outcomes. Moreover, the placenta could serve as a biomarker for fetal distress, as the presence of severe lesions indicates an increased risk for reduced neonatal survival. Full article

We present the case of a 27-year-old woman diagnosed with Löffler’s endomyocarditis complicated by intraventricular thrombus and cerebral infarction. She was treated with prednisolone and anticoagulation therapy; however, tapering of corticosteroids resulted in recurrence of intraventricular thrombosis. Given disease relapse after medication withdrawal, lifelong anticoagulation was indicated. At 29 years of age, she sought pregnancy counseling. Conception was permitted after stabilization of prednisolone dosage, with a planned switch from a vitamin K antagonist to therapeutic-dose unfractionated heparin during pregnancy. Following disease stabilization, she conceived via artificial insemination. Serial echocardiography at 22 and 34 weeks of gestation demonstrated preserved cardiac function without thrombus recurrence. She delivered a healthy infant by emergency cesarean section at 39 weeks of gestation due to fetal distress. No thrombus recurrence was observed postpartum, and she remained clinically stable during 13 months of follow-up. This represents the case of a successful pregnancy in a woman with a history of recurrent intraventricular thrombosis due to Löffler’s endomyocarditis, highlighting the importance of early diagnosis, sustained immunosuppression, individualized anticoagulation, and multidisciplinary preconception planning. Full article

Placental abruption (PA) without vaginal bleeding is known to be associated with severe outcomes when compared to symptomatic cases; the presence of hypertensive disorders of pregnancy (HDP) is an additional negative prognostic factor. According to guidelines, severe HDP are indications for prompt delivery after maternal–fetal stabilization. Considering gestational age, parity and clinical obstetric examination, the induction of labor should be prioritized to avoid additional risks associated with cesarean section. However, since only a minority of cases of PA may be detected by ultrasonography (US), findings consistent with this suspicion should contribute to the establishment of an appropriate mode of delivery. We present two cases affected by severe HDP, eclampsia and HELLP syndrome, admitted to St. Luke Catholic Hospital, Wolisso, Ethiopia. In both cases, obstetric point-of-care (POC) US revealed a live premature fetus and a solid heterogeneous placental mass, raising the suspicion of concealed placental abruption. To expedite delivery, cesarean section was promptly offered. PA was confirmed in both cases; the first had stillbirth and postpartum hemorrhage, while the second ended up with healthy mother and newborn. In conclusion, POC-US imaging could play a role in optimizing delivery mode and timing for patients with HDP in low-resourced settings. Additional research is warranted to determine the impact of this technique in the management of obstetric emergencies. Full article

Background: Although thrombophilia represents a major risk factor for adverse maternal outcomes, particularly in the postpartum period, methods for its systematic screening remain costly and limited. This case–control study aimed to evaluate whether routinely available hematological inflammatory indices combined with postpartum uterine ultrasonographic assessment can predict the presence of thrombophilia in peripartum women. Methods: Eighty women with previously diagnosed and treated thrombophilia undergoing cesarean section at term were prospectively enrolled and matched by age and parity with 80 control patients without thrombophilia. Hematological inflammatory markers derived from complete blood counts obtained within 24 h before delivery and the postpartum uterine ultrasonographic score were analyzed. Multivariable logistic regression was performed to identify independent predictors of thrombophilia, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Impaired postpartum uterine involution—defined as a postpartum uterine ultrasonographic score ic—was significantly more frequent in thrombophilia cases than in controls (OR > 1, 95% CI excluding 1; p < 0.05). Thrombophilia patients exhibited significantly higher Neutrophil-to-Lymphocyte and Platelet Ratio and Cumulative Inflammatory Index values when compared with the controls, with both emerging as independent predictors in the multivariable model (OR > 1, 95% CI excluding 1; p < 0.05). The final model demonstrated good discriminative performance, with an overall classification accuracy of 88.6% and excellent specificity for excluding thrombophilia when the postpartum uterine ultrasonographic score was 0. Conclusions: The integration of postpartum uterine ultrasonographic assessment with simple hematological inflammatory indices provides a non-invasive, cost-effective approach for identifying women at increased risk of underlying thrombophilia in the immediate postpartum period. This strategy may support targeted thromboprophylaxis and rationalize the use of specialized thrombophilia testing. Full article

Background: Pre-eclampsia causes endothelial dysfunction and altered vascular reactivity, which may increase perioperative risk, particularly under the physiologic stress of general anesthesia (GA). However, the evidence regarding its independent effects under uniform GA conditions is limited. This study assessed the association between pre-eclampsia and intraoperative hemodynamic stability as well as postoperative complications in women undergoing cesarean section under GA. Methods: This retrospective cohort study screened 1242 women who underwent GA for cesarean delivery between January 2017 and July 2024. After applying exclusion criteria, 959 patients were included: 169 with and 790 without pre-eclampsia. The intraoperative blood-pressure and heart-rate trends, vasopressor use, operative variables, and postoperative complications were analyzed. Predictors of postoperative respiratory complications were identified using logistic regression with Firth correction. Results: Patients with pre-eclampsia showed consistently higher mean arterial pressures throughout induction and emergence, whereas trends in heart rate were similar. Postoperative morbidity was higher in the pre-eclampsia group (11.8% vs. 5.3%), with increased respiratory complications (3.6% vs. 1.1%) and longer hospital stays. Pre-eclampsia independently predicted postoperative respiratory complications in univariable (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.13–8.90, p = 0.03), multivariable (OR 3.13, 95% CI 1.09–8.98, p = 0.03), and Firth’s analyses (OR 3.21, 95% CI 1.11–8.77, p = 0.03). Conclusions: Pre-eclampsia was associated with persistent intraoperative hypertension and higher risks of postoperative respiratory morbidity under GA. These findings support the need for individualized hemodynamic control, cautious fluid management, and increased postoperative respiratory surveillance in patients with pre-eclampsia. Full article

Background: Gestational weight gain (GWG) is commonly used as an indicator of nutritional adequacy during pregnancy and a marker for pregnancy outcomes. This study aims to report the prevalence and extent of GWG inadequacy among Saudi women and to examine the effects of GWG inadequacy on pregnancy outcomes. Methods: This study was conducted as part of the Riyadh Mother and Baby Multicenter Cohort Study; it included 6984 women with singleton pregnancies. Adverse pregnancy outcomes—including hypertension, gestational diabetes (GDM), cesarean section (CS), low birth weight (LBW), Neonatal Intensive Care Unit admission (NICU), and macrosomia—were compared between women with adequate and inadequate GWG, based on the Institute of Medicine (IOM) guidelines. Results: Of the participants, 2221 women (31.8%) had adequate GWG for prepregnancy BMI, 2959 (42.4%) had inadequate GWG, and 1804 (25.8%) had excessive GWG. Women with normal prepregnancy BMI and inadequate GWG had significantly increased odds of delivering LBW infants (adjusted odds ratio (AOR) = 1.61, 95% CI: 1.17–2.20). Inadequate GWG also decreased the odds of emergency cesarean delivery among women with obesity (AOR = 0.75, 95% CI: 0.56–0.97) and lowered the likelihood of NICU admission for infants of obese women (AOR = 0.59, 95% CI: 0.36–0.97). Women with prepregnancy obesity experienced the highest rate of adverse outcomes; however, the prevalence of all adverse outcomes decreased as the degree of weight gain inadequacy increased. Conversely, underweight women had the highest percentage of LBW, with this percentage increasing as weight gain inadequacy increased. Conclusions: The effects of inadequate GWG vary depending on maternal prepregnancy BMI and the specific outcome assessed. For women with obesity, reduced weight gain during pregnancy may be beneficial. In contrast, inadequate GWG is associated with a higher incidence of LBW in women with normal prepregnancy BMI and underweight women. Full article

Background: Perinatal hypoxia is a leading cause of early mortality in canine neonates and accounts for over 90% of early deaths in canine neonates. Respiratory depression may result from dystocia, prolonged labor, or anesthetic protocols used during cesarean delivery, requiring rapid pharmacological support. This study evaluated the effects of aminophylline, caffeine, and doxapram on clinical and biochemical viability parameters in hypoxic neonatal dogs. Methods: Forty-five puppies born via elective or emergency cesarean section were included, of which 35 exhibiting cardiorespiratory depression (heart rate ≤ 180 bpm, respiratory rate < 15 movements per minute, Apgar score < 7, and reflex score < 3) were randomly allocated into aminophylline group (AG; n = 12), caffeine group (CafG; n = 11), or doxapram group (DG; n = 12). Ten clinically healthy neonates constituted the physiological control group (CG). Apgar score, neonatal reflexes, lactate, blood glucose, oxygen saturation, blood gas parameters, and cardiac troponin I (cTnI) were evaluated immediately after birth (M1) and 10 min following treatment (M10). Results: No significant differences were observed in laboratory parameters among groups (p > 0.05). Although all evaluated drugs improved clinical status by increasing heart rate, respiratory rate, and reflex scores, caffeine produced the greatest enhancement in vitality. The Δ Apgar score showed a significant difference between CafG and DG (p = 0.0095), while no statistical differences were detected between AG and CafG (p = 0.08) or between AG and GD (p = 0.60). Conclusions: Aminophylline, caffeine, and doxapram supported postnatal resuscitation in hypoxic neonatal puppies; however, caffeine demonstrated superior improvement in Apgar recovery, suggesting its potential as a preferred pharmacological adjunct in neonatal canine resuscitation protocols. Full article

Background: We aimed to compare the perinatal outcomes of dichorionic/diamniotic twin (DC/DA) pregnancies resulting from in vitro fertilization (IVF) with those resulting from spontaneous DC/DA pregnancies. Methods: The study group included 99 women with DC/DA pregnancies resulting from IVF, and the control group included 92 women with spontaneous DC/DA pregnancies. Maternal demographic characteristics (age, parity, and gravidity), pre-existing conditions (chronic hypertension and pregestational diabetes mellitus), and obstetric history were recorded. Pregnancy outcomes included gestational age at delivery, number of fetuses, and mode of delivery. The antepartum complications that we evaluated include first- and second-trimester bleeding, placenta previa, preterm birth, fetal growth restriction (FGR), oligohydramnios, and tocolytic use. The obstetric complications that we assessed include prematurity, twin-to-twin transfusion syndrome (TTTS), and hydrops fetalis. Additionally, neonatal data such as 1st minute and 5th minute Apgar scores, birth weight, neonatal intensive care unit (NICU) admission, presence of congenital anomalies, and neonatal death were recorded, and comparisons were made between the groups. Results: Women in the IVF group were older (34.7 ± 6.9 vs. 32.3 ± 6.1 years, p = 0.03) and more frequently primiparous (73.7% vs. 37.0%, p < 0.001). The mean gestational age at delivery was slightly lower in the IVF group, though this was not statistically significant (34.3 ± 3.5 vs. 35.1 ± 2.5 weeks, p = 0.101). Cesarean delivery was common in both groups, with comparable overall rates (90.9% vs. 94.6%, p = 0.411), but emergency cesarean section occurred more frequently in IVF pregnancies (81.8% vs. 55.8%, p = 0.001). No significant differences were found regarding chronic hypertension or pregestational diabetes. However, several differences were demonstrated in terms of obstetric complications. For example, preterm births and fetal growth restriction (FGR) were significantly more frequent in IVF pregnancies (59.8% vs. 30.4%, p < 0.001), and tocolytic use was also more frequent (56.6% vs. 29.7%, p < 0.001). No significant differences were observed in terms of placenta previa, oligohydramnios, TTTS, hydrops fetalis, and neonatal outcomes. The logistic regression analysis revealed that IVF pregnancies were associated with an increased risk of preterm birth: OR 3.45, 95% CI 1.85–6.78 (p < 0.001); the risk of FGR was also higher in IVF pregnancies: OR 2.11, 95% CI 1.02–4.37 (p = 0.015). However, tocolytic use was not significantly associated with IVF: OR 1.49, 95% CI 0.50–4.44 (p = 0.471). Conclusions: Although DC/DA pregnancies conceived through IVF have a higher risk of preterm birth, fetal growth restriction, and greater use of tocolytic agents than spontaneous DC/DA pregnancies, their neonatal outcomes are similar. Full article

Background: Delays in emergency cesarean section (CS) remain a major contributor to maternal and neonatal morbidity in low-resource settings. This study evaluated the combined effect of a mobile-based obstetric emergency system (MORES) and a midwife-led triage program on the decision-to-incision interval (DDI) and related outcomes in Liberia. Methods: A quasi-experimental study with an interrupted time series design was conducted in Bong County across two district hospitals receiving referrals from 20 rural health facilities. Seventy-two women referred for emergency CS were observed at baseline, midline, and endline. MORES used WhatsApp-based communication to improve referral coordination, while the triage program trained midwives to rapidly assess cases using a color-coded system. Data were analyzed using descriptive statistics, Wilcoxon rank-sum, chi-squared tests, and logistic regression. Results: By endline, the median DDI decreased by 117.5 min compared to baseline (95% CI: −205.1 to −29.9). Women were significantly more likely to receive a CS within 75 min (AOR: 11.7; 95% CI: 1.32 to 104.5). No maternal deaths occurred. Neonatal mortality was observed but not significantly associated with DDI. Conclusions: MORES and midwife-led triage substantially improved the timeliness of emergency CS in a resource-constrained setting. These low-cost, feasible strategies warrant further evaluation for sustainability and impact on neonatal outcomes. Full article

Background and Objectives: Maternal telomere length (TL) has been proposed as a potential biomarker of biological aging and pregnancy outcomes, yet evidence in Central and Eastern European populations remains scarce. This study aimed to investigate the association between maternal TL and neonatal parameters in a clinically healthy cohort. Materials and Methods: We conducted a prospective observational study including 134 mother–infant pairs at the “Pius Brînzeu” Emergency County Clinical Hospital, Timișoara. All deliveries were performed by cesarean section for maternal indications unrelated to fetal condition. Maternal blood samples were collected at admission, and relative TL was measured by quantitative PCR. Neonatal outcomes included birth weight, length, head circumference, gestational age, and Apgar scores. Results: Longer maternal TL was positively correlated with birth weight (r = 0.515, p < 0.001), length (r = 0.559, p < 0.001), head circumference (r = 0.468, p < 0.001), gestational age (r = 0.444, p < 0.001), and Apgar scores at 1 (r = 0.714, p < 0.001) and 5 min (r = 0.684, p < 0.001). Logistic regression showed that shorter maternal TL independently predicted suboptimal 1 min Apgar (<8), with an adjusted odds ratio of 0.68 (95% CI: 0.51–0.91). Conclusions: Maternal TL is strongly associated with neonatal growth and vitality measures, supporting its potential as a simple, non-invasive biomarker for perinatal risk assessment. Full article

This review explores the impact of maternal obesity on pregnancy outcomes, emphasizing its significant global health challenge and profound implications for both mothers and infants. It influences the timing and mode of childbirth, elevating the risk of conditions like hypertensive disorders, cesarean delivery, and gestational diabetes mellitus. The review focuses on analyzing how maternal obesity affects postpartum recovery, birth timing, and delivery methods. Relevant studies were identified using PubMed and Scopus. Findings indicate that obese pregnant women are at higher risk for medically indicated preterm birth, scheduled and emergency cesarean sections, and labor induction. Postpartum recovery is often prolonged due to breastfeeding challenges, infection risks, and delayed wound healing. Additionally, maternal obesity increases the likelihood of fetal complications such as macrosomia and long-term metabolic disorders. These results highlight the importance of personalized treatments and early weight control to improve the health of both mother and baby. A comprehensive approach integrating clinical care, public health initiatives, and policy measures is essential to reduce pregnancy complications associated with obesity. Full article

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication deficits, repetitive behaviors, and frequent gastrointestinal comorbidities. Emerging research suggests gut microbiota alterations contribute to ASD symptoms and gastrointestinal dysfunction, but detailed microbial profiles and clinical correlations remain underexplored. Methods: This study analyzed gut microbiota in 45 children aged 2–18 years diagnosed with ASD. Stool samples underwent 16S rRNA gene sequencing. Clinical assessments included ASD diagnostic subtype, adaptive functioning using the Vineland Adaptive Behavior Scale, gastrointestinal symptoms as per the Rome IV criteria, dietary patterns, and demographic variables. Statistical analyses correlated microbiota profiles with clinical features. Results: Gut microbiota composition was significantly influenced by delivery mode, age, sex, and diet. Vaginally delivered children had higher beneficial SCFA-producing bacteria, whereas Cesarean section was linked to increased pathogenic Clostridiales. High-calorie and protein-rich diets correlated with shifts toward pro-inflammatory taxa. Microbial diversity and specific genera correlated with adaptive behavior domains (communication, socialization, motor skills) and severity of gastrointestinal symptoms. Both pro-inflammatory and anti-inflammatory bacteria variably impacted neurodevelopmental outcomes. Conclusions: Gut microbiota composition in children with ASD is shaped by multifactorial influences and connected to neurobehavioral and gastrointestinal phenotypes. The findings of this study support the potential of microbiota-targeted interventions to ameliorate ASD-associated symptoms and improve quality of life. Full article