Search Results (607)

Background and Objectives: Adolescent pregnancy is traditionally associated with increased obstetric risk, particularly among very young adolescents. Romania continues to report one of the highest adolescent birth rates in the European Union, yet age-stratified clinical data on obstetric outcomes among minors remain limited. This study aimed to evaluate maternal and intrapartum outcomes among underage mothers (<18 years), stratified by age (<15, 15–16, and 17 years), and to identify predictors of adverse obstetric outcomes. Materials and Methods: We conducted a retrospective cohort study of all live births and stillbirths among mothers aged 12–17 years recorded between 2020 and 2024 at a secondary maternity hospital in Romania. Data were extracted from standardized obstetric and neonatal records. Primary outcomes included preterm birth (<37 weeks), cesarean delivery, and intrapartum complications. Group comparisons were performed using non-parametric tests and the χ² test. Multivariable logistic regression models were used to assess independent associations between maternal age and obstetric outcomes. Results: The cohort comprised 763 adolescent mothers aged 12–17 years. No significant differences were observed across age groups in gestational age at birth, preterm birth rate, fetal presentation, or mode of delivery. In multivariable analyses, younger maternal age was not independently associated with preterm birth (adjusted odds ratios [aORs] 0.87–1.21) or cesarean delivery (aORs 0.74–1.08). Obstetric factors, such as non-cephalic presentation and characteristics of membrane rupture, were the main predictors of adverse outcomes. Temporal analyses demonstrated stable outcome patterns across the study period, with no significant interaction between maternal age and year of delivery. Conclusions: In this tertiary-care cohort, very young maternal age (<15 years) was not associated with poorer obstetric outcomes compared with older adolescents. These findings suggest that standardized antenatal surveillance and intrapartum management may mitigate age-related obstetric risk among underage mothers. Further population-based studies are warranted to contextualize these results within broader healthcare access and social determinants of adolescent pregnancy. Cesarean section rates were high across all groups (~50%), with no significant differences by maternal age. Full article

Objective: Isolated gestational proteinuria (IGP) has traditionally been considered a benign condition; however, emerging evidence suggests that it may represent an early stage in the spectrum of preeclampsia. This study aimed to evaluate clinical and laboratory predictors of progression from IGP to preeclampsia. Methods: This retrospective cohort study included pregnant women diagnosed with proteinuria ≥ 300 mg/day after 20 weeks of gestation between January 2023 and December 2024. After applying predefined exclusion criteria, 319 women with isolated gestational proteinuria (IGP) were included and stratified according to progression to preeclampsia (n = 42, 17.8%). Baseline clinical and laboratory parameters were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of progression, and receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of significant variables. Results: Preeclampsia developed in 17.8% of women with IGP. In multivariable analysis, higher maternal body mass index (aOR 1.085, p = 0.028) and earlier gestational age at diagnosis (aOR 0.883, p = 0.011) were identified as independent predictors of progression. Although neutrophil count and systemic inflammatory indices were elevated in univariate analyses, they did not retain independent predictive value after adjustment. Conclusions: In pregnancies complicated by isolated gestational proteinuria, clinical parameters appear to be more informative than inflammatory and renal markers for predicting progression to preeclampsia. Laboratory-derived indices offer limited additional value and should be interpreted cautiously in risk assessment. Full article

Alpha-fetoprotein (AFP) is a glycoprotein primarily produced by the fetal liver and yolk sac during development. It is a multifaceted biomarker with significant applications in the prenatal screening of congenital abnormalities, cancer, and other disorders. The level of AFP in maternal blood may indicate several obstetric concerns and complications during pregnancy. Atypical AFP levels are commonly utilized as a biomarker for detecting fetal anomalies, placental complications, and other pregnancy-related issues. These findings raise concerns regarding the effectiveness of screening maternal serum alpha-fetoprotein (MS-AFP) as a primary indicator of pregnancy problems and underscore the need for further investigation into the functional role of AFP throughout pregnancy. The measurement of MS-AFP has been utilized for the past four decades. It is anticipated that MS-AFP measurement will continue to be utilized as a component of integrated or sequential tests for chromosomal abnormalities and may serve as a prognostic indicator for adverse obstetric outcomes. Critically, whether AFP functions solely as a passive marker or plays active biological roles in pregnancy physiology and pathology remains unresolved, necessitating additional mechanistic investigation and discourse. This review consolidates critical data from numerous studies on AFP, focusing specifically on its diagnostic and prognostic applications for congenital abnormalities and problems during pregnancy. This review also identifies key research gaps regarding the functional biology of AFP, particularly whether AFP functions as a passive biomarker or an active participant in the pathophysiology of adverse pregnancy outcomes. Full article

Background/Objectives: The COVID-19 pandemic has raised concerns about maternal mental health, particularly among women infected during pregnancy. This study aimed to examine longitudinal changes in depressive and anxiety symptoms and subjective distress among pregnant women in Slovakia with confirmed SARS-CoV-2 infection and to explore the role of obstetric complications and vaccination status in these trajectories. Methods: In this retrospective longitudinal study, women with SARS-CoV-2 infection during pregnancy were assessed at three time points: during infection, six weeks postpartum, and one year postpartum (11 March 2020–5 May 2023). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS; cut-off ≥ 11), anxiety symptoms were measured using the EPDS-3A subscale (cut-off ≥ 5), and subjective distress was measured using visual analogue scales (VAS). A repeated-measures ANCOVA design was used to evaluate within-subject changes over time while adjusting for vaccination status and pregnancy complications. Results: Of 1184 contacted women, 170 provided complete data. The proportion of women exceeding the EPDS cut-off decreased from 27.6% during infection to 17.6% at six weeks postpartum and 4.7% at one year postpartum. Anxiety symptoms showed a similar pattern, declining from 27.6% during infection to 20.6% at six weeks postpartum and 7.6% at one year postpartum. Repeated-measures analyses confirmed significant time effects across psychological outcomes, with symptom levels decreasing over the postpartum year. Post-infection obstetric complications were associated with higher subjective distress at selected time points. Conclusions: Psychological symptoms were highest during the acute infection period and declined significantly over time. These findings support the importance of timely mental health screening during pregnancy affected by COVID-19, while suggesting that, in many women, psychological distress may decrease across the postpartum year. 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: Pregnancy following liver and kidney transplantation is rare. The presence of a rare genetic disorder and advanced chronic kidney disease (CKD) further complicates clinical management, for which evidence-based guidelines are limited. Case presentation: A 29-year-old woman with Alagille syndrome underwent combined liver and kidney transplantation in early childhood. She had stage 4 CKD, and her baseline creatinine was around 250 umol/L. Her pregnancy was unplanned and diagnosed at 19+1 weeks of gestation. After the diagnosis of pregnancy, immunosuppressive therapy was promptly adjusted, and potentially teratogenic medications were discontinued. At 21+1 weeks’ gestation, creatinine and urea levels rose despite multidisciplinary management, and she started renal replacement therapy. Despite ongoing multidisciplinary care, the pregnancy was complicated by placental abruption at 24+5 weeks, requiring a preterm cesarean section. A live-born female infant weighing 590 g was delivered. Discussion: The coexistence of CKD, long-term immunosuppression, and high obstetric risk requires early multidisciplinary assessment and individualized management. Currently, standardized protocols for monitoring and treatment are lacking in this rare population, making clinical decision-making particularly challenging, especially regarding CKD progression. Conclusion: Pregnancy in women with combined liver and kidney transplantation and advanced CKD carries a high risk of severe renal and obstetric complications. Preconception counseling and early referral to multidisciplinary teams may help improve management in similar rare clinical scenarios. Full article

Background: Pregnancy presents unique immunological and obstetrical challenges for women with Common Variable Immune Deficiency (CVID). No standardized guidelines currently exist to guide pregnancy management, as CVID is a rare diagnosis, with pregnancy outcomes limited to case reports and case series. Establishing a structured approach to care is important to optimize maternal and fetal outcomes. Methods: A narrative review of the literature with a structured search was performed to detail pregnancy outcomes in CVID and management strategies. A 10-year retrospective chart review of women with CVID who became pregnant while receiving care at the McGill University Health Centre between January 2015 and January 2025 was conducted to add to the existing clinical data. Results: Pregnancy outcomes were improved through pre-conception planning, regular serum Immunoglobulin G (IgG) monitoring, trimester-based immunoglobulin replacement dose adjustments, proactive management of autoimmune or infectious complications, and multidisciplinary care. Subcutaneous immunoglobulin may offer better flexibility and stability of IgG levels. Conclusions: In the available observational literature and our institutional experience, many patients with CVID have carried pregnancies to term with favorable maternal and neonatal outcomes when managed with IgRT and multidisciplinary coordination. We outline a stepwise multidisciplinary framework for clinicians caring for women with CVID who are planning or undergoing pregnancy, and we identify gaps in knowledge for future studies. Full article

Obstetric anal sphincter injuries (OASIs) are serious complications of vaginal delivery and the most frequent cause of postpartum anal incontinence. Underdiagnosis during delivery persists due to limited availability of accurate imaging. Transperineal ultrasound (TPUS) and endoanal ultrasound (EAUS) enable structural assessment of the anal sphincter and have growing roles in triage, repair planning, and follow-up.The aim of the present review is to integrate current evidence on diagnostic value, clinical usefulness, and potential implementation of TPUS and EAUS in gynecologic practice.Ultrasound identifies a high burden of occult sphincter trauma in primiparas with normal clinical assessment with rates close to 25%. EAUS is currently the gold standard for accurate imaging of defects. TPUS has excellent diagnostic performance for external anal sphincter (EAS) defects and is practical for bedside use. Improving the diagnosis of OASIs requires structured post-delivery clinical examination combined with selective use of TPUS as a first-line imaging modality and EAUS in cases of diagnostic uncertainty or suspected complex injury.Immediate postpartum ultrasound may help reduce delayed diagnoses and support timely surgical repair. Key barriers include operator dependence, training, availability, and variable image quality, particularly for routine EAUS in the labor ward.Incorporating ultrasound into postpartum management improves detection and classification of OASIs and subsequently repair and prognosis. Currently, judicious application in high-risk deliveries seems to be an appropriate approach until more evidence from prospective and economic studies is available. New technologies (3D/4D imaging, standardized terminology, and decision-support/AI) hold promise to increase reproducibility and use in everyday clinical practice. Full article

Background/Objectives: The optimal management of bone-only progressive disease (PD) in metastatic breast cancer remains unclear for several reasons. Radiologic diagnosis of bone PD is complicated by the lack of standardized response assessment criteria, unspecific morphologic changes of the bone, and flare-up phenomena. Furthermore, bone-only disease and oligoprogression have been associated with favorable prognosis challenging a change of systemic treatment with the consequence of limited treatment options in the future. Additionally, bone-only metastatic disease is frequently excluded from clinical trials resulting in scarce data. This study aimed to assess the therapeutic management and outcome of bone-only PD in metastatic breast cancer patients in a real-world academic setting. Methods: A retrospective analysis of all breast cancer patients with bone metastases (BMs) and at least one event of radiologic evidence of bone-only PD and/or the occurrence of a skeletal-related event (SRE) who were treated at the Department of Obstetrics and Gynecology of the Medical University of Vienna, Austria, between 1 January 2015 and 14 December 2021 was performed. In cases of multiple bone-only PD events in one patient only the first event was considered for analysis. All cases with PD in organs other than the bone were excluded. The primary outcome of the study was to assess therapeutic measures of bone-only PD. Secondary outcomes were the time from bone-only PD to next bone PD (TTF BD) and overall survival (OS; time from bone-only PD to death). Predictors of TTF BD and OS were assessed as exploratory outcomes. Results: Out of a total of 308 breast cancer patients with BMs, 57 had at least one event of bone-only PD. In 59.3% of bone-only PD cases the systemic treatment was continued with a numerically higher rate if multiple metastatic sites were present (71.4% vs. 46.4%). In most bone-only PD events the bone-targeted agent (BTA) was continued (94.5%), independent of the total number of metastatic sites. In 24.1% radiotherapy (RT) was administered with similar rates between patients with bone-only and multiple metastatic sites. The median TTF BD was 6.3 months. In multivariate analysis no predictor for TTF BD could be identified including change of systemic treatment, RT, previous BTA treatment duration, number of previous treatment lines for the metastatic disease, number of metastatic sites and previous or current SRE. Median OS was 21.8 months. Number of previous treatment lines for the metastatic setting was significantly associated with OS with shorter OS in the more advanced disease stage (p-value = 0.0208). Conclusions: Systemic and BTA treatment were continued in the majority of bone-only PD cases. In 24.1% RT was administered. No association between change of systemic therapy and improved oncologic outcome was found. The study’s results are hypothesis-generating in terms of whether change of systemic treatment should be performed restrictively to avoid limited treatment options in the future. Similarly, radiotherapy did not ameliorate prognosis. Full article

Obstetrical diseases are complications associated with pregnancy or childbirth that can cause maternal sequelae and fetal complications. Among them, preeclampsia (PE) and preterm labor (PTL) are major causes of premature birth and are associated with an increased risk of cerebral palsy, developmental delay, and hearing impairment in infants. However, reliable diagnostic markers and therapeutic strategies for obstetrical diseases remain limited. The aim of this study was to investigate genes associated with obstetrical diseases and to evaluate the correlation between phosphocholine cytidylyltransferase 1 beta (PCYT1B) and miRNAs targeting PCYT1B for diagnostic analysis in PE and PTL. Using miRNA array analysis and luciferase assays, we identified PCYT1B, a key enzyme involved in phosphocholine metabolism in reproductive tissues, together with several candidate miRNAs targeting PCYT1B, including miR-3065-3p, miR-4660, miR-6752-5p, miR-6842-5p and miR-7110-5p. qRT-PCR analysis revealed a significant correlation between PCYT1B and these miRNAs in placental tissues from patients with PE and PTL (p < 0.05). Immunofluorescence staining further demonstrated that PCYT1B was localized in the syncytiotrophoblast layer of placental tissues, and its protein expression was consistent with mRNA expression levels. To investigate the functional role of these miRNAs, trophoblast cells were treated with miRNA mimics and inhibitors. These treatments significantly altered trophoblast invasion capacity and regulated the expression of migration-related genes, including RhoA, Rac1 and ROCK. Collectively, our findings suggest that miRNAs targeting PCYT1B may regulate trophoblast function and may play a key role in placental development and obstetrical diseases. These results indicate that PCYT1B and its regulatory miRNAs could serve as potential biomarkers for PE and PTL and may provide insights into the development of miRNA-based diagnostic strategies. Full article

In recent times, extracorporeal membrane oxygenation is increasingly employed in pregnant and postpartum patients with severe cardiopulmonary failure. This article presents two illustrative cases from our tertiary care center, highlighting the complexities of obstetric extracorporeal membrane oxygenation management. These cases are described within a synthesis of recent systematic reviews, registry data, and large case series focusing on maternal and fetal outcomes, extracorporeal membrane oxygenation modality impacts, timing of intervention, complication profiles, and anesthetic considerations. The concordance and contrasts between these cases and the existing literature underscore the evolving indications, improving survival rates, and critical perioperative management issues. Emphasis on multidisciplinary care and planning remains essential to optimize outcomes in this unique patient population. Full article

Background/Objectives: Placenta accreta spectrum (PAS) disorders are a major cause of life-threatening obstetric hemorrhage and frequently necessitate cesarean hysterectomy. Abdominal aorta balloon occlusion (AABO) has been increasingly adopted as a strategy to reduce intraoperative blood loss during cesarean section. This study aims to evaluate the effectiveness and safety of AABO during cesarean delivery in women with PAS disorders. Materials and Methods: A systematic review and meta-analysis of studies published in English from 2015 to April 2025 was conducted using the following databases: Embase, Scopus, PubMed, Google Scholar, and Web of Science. Articles that met inclusion criteria focused on human participants, original studies, female participants, and studied the efficacy of AABO on blood loss during cesarean delivery for PAS. Articles that were reviews, case reports, other occlusion procedures, and animal studies were excluded. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Results: Twenty-four studies comprising 1958 cesarean deliveries with AABO and 1791 without AABO met the inclusion criteria. Data on blood loss, transfusion, hysterectomy, maternal complications, and neonatal outcomes were extracted, synthesized, and analyzed. The majority of studies (91.6%) applied the balloon at the infrarenal level. Cesarean delivery with AABO resulted in substantially lower mean blood loss (1231 ± 688 mL vs. 2253 ± 857 mL, p < 0.001) and reduced requirements for blood transfusion compared with cesarean delivery alone. Hysterectomy rates were threefold lower with AABO (7.8% vs. 25.8%, p < 0.001), and the incidence of hemorrhagic shock and re-laparotomy were markedly reduced. Complications associated with AABO, including lower limb arterial thrombosis and fever, were uncommon and generally manageable. Conclusions: AABO during cesarean delivery for PAS disorders is associated with reduced intraoperative blood loss, lower transfusion requirements, and decreased hysterectomy rates, suggesting improved maternal hemodynamic stability. Although the procedure is generally safe, vigilance for vascular and thromboembolic complications is essential, and preventive strategies should be incorporated into perioperative care. These findings support the integration of AABO into multidisciplinary management protocols for women with PAS disorders. Future randomized prospective studies should be performed to improve patient selection criteria, standardize the protocols, and further evaluate the long-term maternal and neonatal safety/outcomes of the procedure. Full article

Background/Objectives: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasingly being used to avoid abdominal incisions; however, its mid-term oncological safety in endometrial cancer remains unclear. Methods: This single-center retrospective cohort study included patients with International Federation of Gynecology and Obstetrics (FIGO) clinical stage IA endometrioid endometrial carcinoma undergoing simple hysterectomy between January 2014 and December 2023. Patients were treated with either total laparoscopic hysterectomy (TLH) or vNOTES. Patients who underwent lymph node assessment were excluded. Follow-up assessed mid-term oncological outcomes. Recurrence-free survival (RFS) was evaluated using the Kaplan–Meier method and compared between the groups, and Cox proportional hazards models were used to identify prognostic factors for RFS. Results: In total, 130 patients were included: 109 underwent TLH and 21 vNOTES. The median follow-up period was 48 and 33 months in the TLH and vNOTES groups, respectively. Postoperative adjuvant therapy was more frequent in the vNOTES group. The operative time was significantly shorter with vNOTES. Postoperative complications were low and similar between the groups. The 3-year RFS was 92.8% and 94.4% in the TLH and vNOTES groups, respectively, without a significant difference (p = 0.874). Lymphovascular space invasion was significantly associated with worse RFS, whereas surgical approach was not significantly associated with RFS. Conclusions: No statistically significant difference in mid-term RFS was observed between vNOTES hysterectomy and conventional TLH in this highly selected low-risk cohort. However, the study was underpowered and subject to residual confounding; therefore, these findings should be considered preliminary and hypothesis-generating. Full article

Despite the availability of clinical guidelines aimed at managing pregnancy complications, maternal deaths related to obstetric emergencies remain unacceptably high in South Africa, especially in rural provinces like Limpopo. These preventable deaths are often linked to delayed response to complications, poor adherence to protocols, and lack of essential resources. The study aimed to explore the experiences of health professionals regarding the implementation of maternal guidelines used to manage obstetric emergencies. The study adopted a qualitative, descriptive, and explorative design. Data were analysed thematically, and trustworthiness was maintained throughout the research process. Sixteen participants from four selected hospitals in a rural area of South Africa (Vhembe District, Limpopo Province) were purposively sampled and interviewed using semi-structured interviews; data were analysed thematically. The findings highlighted multiple critical barriers to guideline implementation, including shortages of printed clinical protocols, inconsistent patient follow-up, poor referral systems, infrastructure deficits, medication stock-outs, and negative staff attitudes. Most doctors and midwives working in maternity units lacked training on the Essential Steps in the Management of Obstetric Emergencies (ESMOE), resulting in insufficient knowledge and skills to manage obstetric emergencies. Therefore, there is an urgent need for comprehensive ESMOE training for all doctors and midwives in maternity units. Full article

Intravenous cannulation is a routine procedure in clinical practice but may rarely be complicated by catheter fracture with intravascular fragment retention. Management is particularly challenging in obstetric patients, where both maternal safety and procedural risks must be carefully balanced. We report the case of a 31-year-old pregnant woman at 21 weeks of gestation admitted for conservative management of preterm prelabor rupture of membranes. Three days after peripheral intravenous catheter placement in the right cephalic vein, catheter fracture with intravascular retention of a fragment was identified. Ultrasound localized the fragment within the cephalic vein, with subsequent migration to the deltopectoral groove. An initial surgical exploration was unsuccessful. Following repeat ultrasound localization, a second surgical procedure performed by an experienced vascular surgeon enabled successful retrieval using a Fogarty catheter. Cephalic vein ligation was performed to prevent further migration. The procedure was completed without complications, and the pregnancy progressed for an additional nine weeks, culminating in preterm delivery of a viable neonate. This case highlights the importance of accurate localization, the need for a stepwise surgical approach after failed initial intervention, and the role of vascular expertise in achieving successful outcomes in complex obstetric patients. Full article