Search Results (416)

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, accounting for approximately 27% of maternal deaths. In Spain, its incidence ranges from 2.5% to 5.2%. Clinical management has evolved toward a stepwise approach integrating pharmacological, mechanical, and surgical interventions. This study aims to analyze the evolution of these techniques during the 2020–2024 period to optimize decision-making and maternal outcomes. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Scopus, and the Cochrane Library for studies published between 2020 and 2024 in English and Spanish. The PICO framework was utilized to evaluate interventions including intrauterine balloon tamponade (UBT), compression sutures, and arterial embolization, prioritizing outcomes such as bleeding control and fertility preservation. Out of 34 identified records, 13 studies met the final inclusion criteria. Results: The findings demonstrate a clear trend toward conservative management. Intrauterine balloon tamponade reported success rates of 80–90% in controlling refractory bleeding and significantly reduced the hysterectomy rates. B-Lynch compression sutures showed success rates between 68.4% and 100%, with generally favorable fertility outcomes. However, combining these sutures with devascularization increased the risk of uterine necrosis. Additionally, the early administration of tranexamic acid (TXA) within 3 h of birth was confirmed as a critical factor in reducing mortality. Conclusions: Acute PPH management has shifted toward protocol-based, sequential, and less invasive strategies. The implementation of standardized algorithms, care bundles, and simulation-based training is essential to reduce decision inertia and improve obstetric safety. While conservative mechanical and surgical techniques are effective, institutional protocols must be regularly updated to consolidate these technological and organizational advances. Full article

Background/Objectives: While satisfactory glycaemic control is possible with specialist care from a diabetologist and modern therapies, women with type 1 diabetes are still subject to poorer obstetric outcomes, even with optimal management. Methods: The analysis comprised a cohort of 55 pregnant patients with type 1 diabetes who attended the Diabetology Outpatient Clinic between 2018 and 2023; all were recruited no later than the first trimester. Qualified patients underwent medical interviews and physical examinations. Insulin pump, continuous glucose monitoring (CGM) system, and postpartum data were collected. Results: The median glycated haemoglobin (HbA1c) at the beginning of pregnancy was 6.1%, with means of 5.9% and 6.0% in the following trimesters. Only 1/3 of the women achieved the recommended HbA1c value throughout pregnancy. The average/median time in range (TIR) in each trimester was ≤70%. Among the women who achieved the recommended TIR target, the infants tended to have lower birth weights but a higher likelihood of jaundice. Almost half of the newborns were large for gestational age (LGA), and a third were macrosomic. The strongest predictor of LGA was a mean blood glucose level > 124 mg/dL in the third trimester, which increased the risk of LGA by almost 12 times. Conclusions: Good diabetes control does not prevent LGA/macrosomia. TIR appears to be a better predictor of obstetric complications, including LGA. A mean glucose level ≥ 124 mg/dL in the third trimester greatly increases the risk of LGA. Full article

Background: Hereditary fibrinogen disorders comprise a rare and heterogeneous group of conditions characterized by highly variable clinical phenotypes, ranging from entirely asymptomatic to severe hemorrhage or paradoxical thrombosis. Within this spectrum, hereditary hypofibrinogenemia (HH) poses a significant obstetrical challenge due to the lack of evidence-based management guidelines during pregnancy. Methods: A scoping review of the literature was conducted to identify reported cases of pregnancies with HH reaching the third trimester. PubMed, Scopus, and Cochrane Library were searched through April 2026 for eligible studies reporting maternal and neonatal outcomes, fibrinogen replacement therapy during pregnancy, and peri- and postpartum management. A complementary LeapSpace search was also performed. Data were extracted using a structured form and owing to the heterogeneity and descriptive nature of the available evidence, results were synthesized narratively. Results: Out of 202 unique records identified, a total of 13 studies, comprising 33 pregnancies, were included. All evidence arose from case reports and small case series, with substantial variability in patient characteristics and clinical management. Successful outcomes are associated with early diagnosis, careful assessment of medical and obstetrical history, and close multidisciplinary surveillance. Maintaining fibrinogen levels above 50–100 mg/dL during pregnancy and ≥150 mg/dL peripartum appeared beneficial. The use of global coagulation assessment tools such as rotational thromboelastometry (ROTEM^®), particularly the FIBTEM^® assay, may support individualized management beyond fibrinogen levels alone; however, up to date it has been incorporated in the management of a single pregnancy. Conclusions: Management of pregnancy in women with HH should be individualized and multidisciplinary, with tailored fibrinogen supplementation strategies to optimize maternal and neonatal outcomes. Small sample sizes and the heterogeneity of the reported results limit the certainty of these findings, requiring further research to establish subtype-specific recommendations and to define additional coagulation parameters that may improve perinatal care. Full article

Background: Adolescent pregnancy is associated with increased maternal and neonatal morbidity, particularly in the context of inadequate prenatal care. Understanding the distribution of maternal and obstetrical complications in this population is important for improving clinical management and pregnancy outcomes. Methods: This retrospective observational study included primiparous adolescent patients (≤18 years) and focused on the assessment of maternal and obstetrical complications. The analysis compared the frequency of these complications between adolescents with adequate prenatal care and those without adequate prenatal follow-up, aiming to identify the most common complications and their distribution according to antenatal care status. Results: Significant differences were identified between groups. Maternal infections were more frequent among patients without adequate prenatal care (24.1% vs. 9.3%, p = 0.039). Hemorrhage was significantly more frequent among patients with adequate prenatal care (59.3% vs. 35.2%, p = 0.012). Among obstetrical complications, cephalopelvic disproportion showed a significant association with prenatal care status (p = 0.034), occurring more frequently in patients without antenatal follow-up. Hypertensive disorders, including gestational hypertension and preeclampsia, were identified only among patients without adequate prenatal care; however, no statistically significant association was observed (p = 0.118). Placenta previa (p = 0.057) and placental abruption (p = 0.495) were also observed only among patients without adequate prenatal care. Conclusions: Primiparous adolescent patients without adequate prenatal care showed a higher frequency of maternal and obstetrical complications, particularly infections and delivery-related disorders. Prenatal monitoring was associated with earlier identification and management of maternal and obstetrical risk factors. These findings highlight the importance of improving access to antenatal care among adolescent populations. Full article

Background: Pregnancies tend to progress without any serious complications. Nonetheless, for a subset of women, obstetric complications may develop, ranging in severity. The most critical of these life-threatening events is referred to as Maternal Near Miss (MNM). To identify the epidemiological and obstetric characteristics, as well as clinical outcomes of MNM cases reported over the year 2021 in the Brazilian state of Paraná. This quantitative, population-based study analyzed 888 notifications that occurred in 2021, obtained from the MNM Notification System. Descriptive statistics and a one-sample Chi-square goodness-of-fit test were applied to the data. Among the women reported, 92.6% were pregnant, the mean age was 29 years, 67.1% identified as white, and 45.2% had preexisting health conditions. Regarding obstetric characteristics, 41.6% were classified as high-risk pregnancies, but nearly one-third (32.3%) of MNM cases occurred in women initially classified as usual risk. The clinical worsening event occurred most frequently during the third trimester (71.9%), and emergency cesarean section was indicated in 60.1% of cases with complete information for this variable. Cesarean delivery predominated over vaginal delivery, with an emergency-to-elective cesarean ratio of approximately 4.7:1. Most women (75%) were discharged after recovery. MNM events are not restricted to women initially classified as high-risk, underscoring the need to strengthen early detection strategies and ensure appropriate management at all levels of care. Improved training of healthcare professionals responsible for reporting and the standardization of MNM monitoring systems in Brazil are also essential. Full article

Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is an uncommon and frequently underdiagnosed condition that typically presents with acute hip pain during late pregnancy or the early postpartum period. Because its clinical presentation is nonspecific and overlaps with pregnancy-related pelvic girdle pain, the diagnosis is often delayed, and the initial management is suboptimal. Although bilateral involvement has been reported, comparative data on diagnostic work-up, multidisciplinary management, and follow-up remain limited. Case Presentation: We report a case of bilateral PR-TOH in a 35-year-old Caucasian primigravida (G1, P0) who presented at 31 + 6 weeks of gestation with progressively worsening bilateral hip pain that culminated in severe functional impairment and wheelchair dependence. Initial ultrasound, laboratory work-up, and rheumatological screening were inconclusive, and intra-articular corticosteroid injections failed to relieve symptoms and were temporally associated with deterioration of glycaemic control and a periorbital and palmar eczematous rash. Magnetic resonance imaging (MRI) demonstrated diffuse bone marrow oedema in both femoral heads with preserved articular cartilage and no evidence of avascular necrosis, supporting a diagnosis of bilateral PR-TOH. Postpartum dual-energy X-ray absorptiometry (DXA) confirmed reduced bone mineral density at both femoral necks (Z-scores below −2.0). Pregnancy was prolonged until 37 + 4 weeks, and delivery was by elective caesarean section. Postpartum care included analgesia, calcium and vitamin D supplementation, structured physiotherapy, and a graded weight-bearing rehabilitation programme. Bone mineral density improved markedly on follow-up DXA at six months, with complete clinical recovery and no further imaging abnormalities at 12, 24, and 30 months. Conclusions: PR-TOH should be considered in pregnant or postpartum women with persistent hip pain and progressive functional limitation. MRI is the key imaging modality for early diagnosis and for excluding alternative causes, whereas DXA remains the reference standard for quantifying bone mineral density and monitoring recovery. Bilateral presentations require a multidisciplinary, individualised approach that addresses both maternal and obstetric outcomes. Full article

Background and Objectives: Preoperative anaemia represents a key modifiable risk factor in obstetrics. Within the framework of Patient Blood Management (PBM), establishing precise hemoglobin (Hb) thresholds is essential for optimal clinical decision-making. This study aimed to assess the predictive value of preoperative hemoglobin levels and to determine the optimal cutoff associated with transfusion risk. Materials and Methods: A retrospective analysis was performed on 932 pregnant women. The association between preoperative hemoglobin, anticoagulant therapy, mode of delivery and maternal age with the need for red blood cell transfusion was evaluated using binary logistic regression and Receiver Operating Characteristic (ROC) curve analysis with the Youden index. Results: Red blood cell transfusion was required in 5.2% (n = 48) of the study population. Logistic regression identified preoperative hemoglobin as the strongest independent predictor (p < 0.001, OR = 0.216, 95% CI: 0.153–0.306), indicating that each 1 g/dL increase in Hb reduced the likelihood of transfusion by 78.4%. Anticoagulant therapy and age were not significant independent predictors (p > 0.05). ROC analysis demonstrated excellent predictive performance, with an Area Under the Curve (AUC) of 0.875 (95% CI: 0.823–0.927, p < 0.001). The optimal threshold for predicting transfusion risk was 10.9 g/dL (sensitivity: 89.6%, specificity: 60.5%). Conclusions: Preoperative hemoglobin concentration is the primary determinant of transfusion risk, outweighing the influence of clinical comorbidities. The integration of PBM protocols designed to sustain hemoglobin levels above 10.9 g/dL is essential to reduce perioperative transfusion requirements and to promote improved maternal safety and clinical outcomes. Full article

Background: Birth defects remain a major global public health concern, particularly in low-resource settings where awareness and preventive practices are limited. Maternal knowledge, attitudes, and practices (KAP) are critical in the prevention and management of birth defects. This study explored contextual factors influencing maternal KAP using a mixed-methods approach in three rural districts of the Eastern Cape, South Africa. Methods: A convergent mixed-methods cross-sectional study was conducted among 72 mothers selected through purposive sampling. Quantitative data were collected using a structured questionnaire administered in English only, covering socio-demographic characteristics, obstetric history, knowledge, and preventive practices. Qualitative data were obtained through interviews exploring beliefs, perceptions, and cultural explanations of birth defects. Quantitative data were analysed using descriptive statistics and linear regression analysis to identify factors associated with birth defects, while qualitative data were thematically analysed to provide contextual understanding. Results: Most participants resided in the Amathole district (63.89%), followed by Alfred Nzo (18.06%) and Joe Gqabi (18.06%). Most women were aged between 20 and 35 years (52.78%), while 15.28% were younger than 20 years and 6.94% were older than 45 years. Over half of the respondents were single (55.56%), 34.72% were married, and the remainder were either separated (4.17%) or divorced (5.56%). Numerous participants had primary education (56; 77.78%), followed by secondary (11; 15.28%) and tertiary education (5; 6.94%). The majority were unemployed (56; 77.78%), while smaller proportions were employed (10; 13.89%) or engaged in other income-generating activities (6; 8.33%), indicating limited participation in formal employment among respondents. Nearly all participants (95.83%) had experienced pregnancy, with 70.83% reporting pregnancy-related complications. Only 2.78% reported having a child with a birth defect, while 90.28% reported a family history of birth defects. Knowledge of genetic causes was relatively high (69.23%), but awareness of modifiable risk factors was limited. Although 93.06% recognized alcohol use during pregnancy as harmful, fewer participants identified smoking or medication use (18.06%) and advanced maternal age (26.39%) as risk factors. Only 13.89% acknowledged the preventive role of antenatal care. Qualitative findings revealed strong cultural influence on perceptions of birth defects, with causes attributed to medical factors (38.89%), supernatural beliefs such as witchcraft or curses (18.06%), immoral behaviour (12.50%), and dietary taboos (11.11%). Traditional health-seeking behaviour was common, with 91.67% consulting traditional healers during pregnancy. Linear regression analysis identified significant predictors of birth defects, including family history (β = 1.36, p = 0.008), alcohol use during pregnancy (β = 1.13, p = 0.050), and inadequate antenatal care attendance (β = 0.99, p = 0.040). Advanced maternal age showed a weaker and non-significant association (β = 0.79, p = 0.080). Conclusions: The study highlights substantial gaps in maternal knowledge and the strong influence of cultural beliefs on birth defect prevention. Strengthening culturally sensitive health education, improving antenatal care services, and engaging traditional healers in community-based interventions are essential to improve maternal health outcomes in rural South Africa. Full article

Background: Acute neurosurgical emergencies during pregnancy are rare but pose significant challenges due to the need for simultaneous management of two interdependent patients. Evidence remains limited, and standardized multidisciplinary protocols are lacking. Case Presentation: A 38-year-old woman at 32 + 4 weeks of gestation presented with acute left hemiparesis secondary to right capsulo-insular intracerebral hemorrhage with mass effect. Following initial conservative management, neurological deterioration and hematoma expansion necessitated emergency craniotomy. A structured multidisciplinary approach was implemented involving neurosurgery, anesthesiology, obstetrics, and neonatology, with predefined roles, continuous intraoperative fetal monitoring, and readiness for emergency cesarean delivery. Anesthetic management balanced maternal neuroprotection with preservation of uteroplacental perfusion. Surgery was completed without fetal compromise. The patient demonstrated neurological improvement and was transferred on postoperative day 13. Elective cesarean delivery was performed at 36 weeks. Conclusions: This case illustrates that emergency neurosurgery during pregnancy may be feasible in selected settings when supported by structured multidisciplinary coordination. Key practical elements included continuous fetal monitoring, predefined team roles, and immediate availability of obstetric and neonatal support. In this individual case, these components facilitated intraoperative decision-making and were associated with favorable maternal and fetal outcomes; however, their individual contribution cannot be determined from a single clinical experience. Further evidence is needed to assess the applicability of this approach across different clinical scenarios. Full article

Background: Sustainable healthcare in obstetric and maternity nursing emphasizes the provision of high-quality, safe, and environmentally responsible care for women and newborns. Nurses’ knowledge, awareness, and clinical practices are central to the implementation of sustainable approaches, including efficient resource management, evidence-based interventions, and patient education. Evaluating these dimensions is essential for identifying gaps, informing targeted training, and supporting sustainable and effective maternal care aligned with global health goals. Accordingly, this study aimed to assess obstetric and maternity nurses’ knowledge, awareness, and clinical practices related to sustainable healthcare. Method: A cross-sectional study design was employed. A convenience sampling technique was used to recruit obstetric and maternity nurses working in the selected study settings during the data collection period. A total sample of 120 participants was targeted. The study was conducted at Al-Azhar University Hospital in New Damietta and selected Family Medicine Centers in Damietta Governorate, Egypt. Data were collected using a structured, self-administered questionnaire developed specifically for this study to assess eco-conscious nursing practices in obstetrics and gynecology units. The questionnaire included sections addressing demographic and professional characteristics, knowledge and awareness of sustainable healthcare, eco-conscious clinical practices in maternity settings, perceived barriers and institutional support, attitudes and advocacy toward environmental sustainability, procedure- and material-related environmental concerns, and energy and water conservation behaviors. Responses were measured using standardized 5-point Likert and frequency scales, with composite scores calculated to categorize levels of knowledge, practices, and attitudes toward sustainability; higher scores indicated greater knowledge, awareness, and engagement in sustainable practices. Results: Overall, among the 120 nurses, of whom 62 (51.7%) had reported having heard about sustainability and received training about it, whereas 58 (48.3%) had not. Most participants held a bachelor’s degree (n = 54, 45.0%), nearly half had more than 10 years of nursing experience (n = 58, 48.3%), and the largest proportion worked in delivery rooms (n = 53, 44.2%). Regarding knowledge, attitude, and practice, good knowledge was observed in 61 participants (50.8%), good practice in 46 participants (38.3%), and positive attitudes in 108 participants (90.0%). The findings also showed that trained nurses in obstetrics and gynecology units demonstrated significantly higher knowledge, more positive attitudes, and better eco-conscious practices compared to untrained nurses across all domains (p < 0.001). Conclusions: The study demonstrates that maternity nurses showed moderate to high awareness and positive attitudes toward sustainability, while environmentally sustainable practices were less consistently implemented, indicating a clear knowledge–attitude–practice gap. Nurses who received sustainability-related training consistently achieved significantly higher knowledge, attitude, and practice scores than untrained nurses. Full article

Background/Objectives: The aim of this study was to evaluate the association between hypertensive disorders of pregnancy and the frequency of urinary incontinence and lower urinary tract symptoms and to assess the impact of these symptoms on quality of life in pregnant women. Methods: This observational comparative study was conducted between March 2024 and September 2025 and included 182 pregnant women between 24 and 40 weeks of gestation. The study group consisted of 91 pregnant women diagnosed with hypertensive disorders of pregnancy, while 91 normotensive pregnant women served as controls. Demographic and obstetric characteristics were recorded. Urinary incontinence and selected lower urinary tract symptoms, as well as the impact of urinary symptoms on quality of life, were assessed using the International Consultation on Incontinence Questionnaire–Short Form, Urinary Distress Inventory-6, and Incontinence Impact Questionnaire-7. Logistic regression analyses were performed to identify independent factors associated with the presence of urinary incontinence. Results: Urinary incontinence was significantly more frequent in the hypertensive group compared with controls (65.9% vs. 20.9%, p < 0.001). Lower urinary tract symptoms were also more prevalent among hypertensive pregnant women (71.5% vs. 53.8%, p = 0.011). UDI-6, ICIQ-SF, and total IIQ-7 scores were significantly higher in the hypertensive group, indicating greater symptom severity and worse quality of life (all p < 0.001). In multivariable logistic regression analysis including the entire study population, hypertensive pregnancy was independently associated with urinary incontinence (OR: 8.33, 95% CI: 4.00–16.67, p < 0.001), whereas age, body mass index, smoking status, and gravida were not independently associated with UI. Conclusions: Hypertensive disorders of pregnancy are strongly and independently associated with an increased frequency of urinary incontinence and lower urinary tract symptoms, as well as a significant deterioration in quality of life. These findings highlight the importance of routine evaluation of urinary symptoms in hypertensive pregnancies and support a multidisciplinary approach to their management. Full article

The Erlang B equation is directly applicable to smaller hospital departments such as maternity and paediatrics departments. The bed occupancy margin is directly linked to size and not ‘efficiency’. A figure of 0.1% turn-away has been recommended as a planning target, i.e., only 1 in a thousand admissions suffer a delay before a bed can be found. Two bed calculators are provided which can be used for paediatric, obstetric, maternity, midwife-led, birthing wards and neonatal/paediatric critical care capacity. The negative effects of turn-away are likely to be context specific, hence, critical care > theatres > birthing unit > maternity unit. The uncertainty regarding future births is discussed along with the variable nature of seasonality in births. For paediatrics, much of bed demand is also influenced by the trend in births. Weighted population density (WPD) is associated with the size distribution of hospitals/units within countries and regions. This influences the average cost per birth/admission. The USA has a low WPD and a significant problem with small hospitals/departments. Only 10% of countries have WPD higher than England. Some countries choose to operate with even more hospitals than needed and this acts to elevate costs. Suggestions are made for a pragmatic approach to bed planning, especially where a dispersed population dictates a need for small hospitals, and hence, issues regarding size and costs. For maternity/paediatrics admissions (and other relatively short-stay admissions) the majority of overhead/indirect costs and most staffing costs should be apportioned based on admissions, and not LOS. Apportionment based on LOS creates the spurious illusion that LOS is the major cost driver and that reducing LOS will immediately save costs. Below 20 beds, Poisson statistical variation plus environment-induced randomness in daily arrivals imply that staff costs may become increasingly fixed irrespective of LOS. Around >30 beds, it looks possible to save costs by reducing LOS. Allocating total organizational costs to individual units and then to patients is less precise than realized and can be done in different ways, which all heavily rely on the steady-state assumption. When bed availability is the bottleneck, then reducing LOS may increase throughput per bed and increase income; however, is this for the benefit of the patient or for the benefit of the organization, and does it lead to higher unanticipated total costs including patient harm? The older economy-of-scale literature has been demonstrated to be flawed, with a recent focus on economy of scale at the department level being entirely consistent with the application of the Erlang B equation. A list of nine catastrophic pitfalls is given for doctors to identify dubious capacity advice from managers and external experts. Full article

Background/Objectives: Teratomas of the sacrococcygeal region are rare, but the most common tumors found in fetuses. They develop from the three germ layers—mesoderm, ectoderm, and endoderm—and occur at a rate of 1 in 27,000 to 1 in 40,000, with a fourfold higher incidence in female fetuses. 63.9–74% of sacrococcygeal teratomas are detected prenatally, most often in the second trimester. Methods: This study reports the case of a woman in her second pregnancy at 29 weeks and 2 days gestation who was incidentally diagnosed with tumor-like lesion in the sacrococcygeal region of fetus. The clinical situation required the pregnancy to be delivered by emergency cesarean section, and the tumor was surgically removed within the first few days of life. The lesion was finally diagnosed as an immature teratoma, and appropriate management was initiated, resulting in stabilization of the child’s general condition and proper development. Results: Detailed imaging and characterization of the lesion are essential for determining the appropriate management and minimizing foreseeable obstetric and neonatal complications. Fetal echocardiography in cases of suspected teratoma in the sacrococcygeal region is essential for identifying life-threatening risk factors and influences the planning of further management. The choice of treatment depends on the clinical situation; among intrauterine interventions and pharmacological therapy, it has been demonstrated that surgical removal of the lesion within the first days of life reduces the risk of recurrence. Conclusions: In any case where lesion such as tumor of the sacrococcygeal region of fetus is suspected, the pregnant woman should be managed at a tertiary care center to ensure multidisciplinary care involving obstetricians, neonatologists, pediatric surgeons, and oncologists. This study provides a review of the literature on methods of diagnosis and treatment of sacrococcygeal teratomas in fetuses. It emphasizes the importance of accurate diagnosis and prenatal care in such cases and their impact on further management. Full article

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

Postpartum hemorrhage (PPH) is a high-stakes obstetric emergency in which delayed recognition and inadequate structured management may result in severe maternal morbidity. Medical students have limited exposure to such scenarios during clinical rotations, raising concerns regarding preparedness for emergency obstetric care. Simulation-based training has been proposed to address this situation; however, its impact on emergency-specific performance, confidence calibration, and determinants of skill acquisition remains incompletely understood. Methods: A single-group prospective pre–post-educational intervention study was conducted among sixth-year medical students following an obstetrics and gynecology rotation. Participants completed a structured high-fidelity simulation module focused on PPH management. Outcomes included an objective composite performance score and self-assessed emergency confidence. Results: A total of 215 students were included. Simulation-based training resulted in substantial improvements in PPH composite performance (scaled 0–1: 0.34 ± 0.20 to 0.67 ± 0.23; p < 0.001; Cohen’s dz = 1.38). Conclusions: Structured simulation-based PPH training markedly enhances emergency management performance among final-year medical students. Learning gains are primarily determined by baseline competence, while motivational responses are influenced by perceived realism, supporting the integration of structured emergency simulation into undergraduate curricula. Full article