Search Results (2,495)

Background/Objectives: Therapeutic plasma exchange (TPE) is an extracorporeal treatment used in thrombotic microangiopathies (TMAs) and various autoimmune and neurological disorders. However, data regarding its use during early pregnancy remain limited. This study aimed to evaluate maternal laboratory response and perinatal outcomes in pregnant women who underwent TPE before 26 weeks of gestation. Methods: This retrospective case series included 10 pregnant women diagnosed before 26 weeks of gestation who underwent TPE between 2010 and 2023. Clinical and laboratory parameters before and after TPE were compared. Results: Indications for TPE included HELLP syndrome (n = 4), thrombotic thrombocytopenic purpura (n = 3), presumed atypical haemolytic uremic syndrome (n = 1), neuromyelitis optica (n = 1), and Guillain–Barré syndrome (n = 1). The mean gestational age at diagnosis was 22.1 ± 3.1 weeks, and the mean gestational age at delivery was 27.1 ± 6.9 weeks. Five fetuses (50%) died and five (50%) survived to discharge. In patients with TMAs, TPE was associated with significant decreases in LDH, INR, APTT, ALT, AST, and total bilirubin levels, along with a significant increase in platelet count and ADAMTS13 activity (p < 0.01). No maternal complications occurred in neurological cases, all of which resulted in term deliveries with healthy neonates. Conclusions: In this uncontrolled case series, TPE was associated with rapid maternal clinical and laboratory improvement in selected pregnant women with TMAs, although a causal effect cannot be established from these data. However, perinatal outcomes were primarily determined by gestational age at delivery: all fetal losses occurred before 26 weeks, whereas all infants survived when delivery occurred after 26 weeks. Larger studies are needed to confirm these findings. Full article

During pregnancy, hormonal, metabolic, and immunological changes influence the composition and function of maternal microbial communities. Increasing evidence suggests that the maternal microbiota—particularly in the vaginal, gut, and oral environments—plays a significant role in maintaining pregnancy homeostasis and supporting fetal development. In healthy pregnancies, the vaginal microbiota is typically dominated by Lactobacillus species, which help maintain a low vaginal pH and protect against ascending infections. However, disruption of this balance (vaginal dysbiosis) has been associated with obstetrical complications such as intrauterine infection and preterm birth. Similarly, the maternal gut microbiota undergoes trimester-specific changes that contribute to metabolic adaptations required for fetal growth, while alterations in microbial composition have been linked to metabolic disorders including gestational diabetes mellitus and preeclampsia. Changes in oral microbiota and periodontal disease have also been associated with adverse pregnancy outcomes through systemic inflammatory pathways and potential microbial translocation to the placenta. Recent advances in sequencing technologies have improved the understanding of host–microbiome interactions in pregnancy, although the existence of a placental microbiome remains controversial. Overall, maternal microbiota plays an important role in pregnancy physiology, and its dysregulation may contribute to obstetrical complications. Understanding these mechanisms may facilitate the development of microbiome-based diagnostic and therapeutic strategies in maternal–fetal medicine. Full article

Introduction: Obstructed HemiVagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome, also known as Herlyn–Werner–Wunderlich syndrome, is a rare congenital Müllerian duct anomaly, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Symptoms typically appear shortly after menarche and include dysmenorrhea and pelvic pain. The psychological burden associated with fertility and reproductive outcomes in women with OHVIRA syndrome remains poorly investigated. Materials and methods: A 30-year-old primigravida with left renal agenesis and a history of vaginal abscess, dysmenorrhea, and chronic pelvic pain received a delayed OHVIRA syndrome diagnosis. The patient had previously been informed that spontaneous conception and an uncomplicated pregnancy were highly unlikely because of her congenital gynecological condition, resulting in significant fertility-related anxiety and psychological distress. Under careful supervision and counseling, she conceived successfully, and the pregnancy progressed without complications; an elective cesarean section was performed at term. A literature search using the PubMed and Embase databases was conducted between November 2025 to April 2026 to identify studies reporting reproductive outcomes and psychological aspects in patients diagnosed with OHVIRA syndrome and other Müllerian anomalies. Results: Evidence-based counseling contributed to improvement of quality of life and reduction of pregnancy-related anxiety of the reported patient with OHVIRA syndrome. A limited number of studies discuss the mental burden and fertility-related anxiety of patients with OHVIRA syndrome and other Müllerian anomalies. Conclusions: Spontaneous conception and uncomplicated pregnancy are possible for women with OHVIRA syndrome. The psychological burden associated with congenital gynecological conditions remains under-recognized and requires further investigation. Comprehensive counseling and interdisciplinary care are essential to improve reproductive education, mental health support, and pregnancy outcomes in patients with congenital gynecological anomalies. Full article

Background: Preterm premature rupture of membranes (PPROM) before 32 weeks of gestation with prolonged latency is associated with substantial neonatal morbidity, including Dry Lung Syndrome (DLS), pulmonary hypoplasia (PH), bronchopulmonary dysplasia (BPD), and death. Accurate individualized risk stratification remains elusive, as the interacting contributions of amniotic fluid dynamics, inflammatory status, and microbiological burden are inadequately captured by traditional statistical approaches. Methods: We performed a retrospective, exploratory–predictive analysis of 66 pregnancies complicated by second-trimester PPROM with latency exceeding 14 days. Elastic Net and Random Forest models were trained across six clinically defined predictor domains using a multi-stage block modelling strategy. To address the clinically relevant distinction between antenatal and postnatal information, results are reported separately for Model A—comprising exclusively antenatal predictors available during expectant management (gestational age at PPROM, latency, amniotic fluid trajectory, inflammatory status, vaginal microbiome at admission)—and Model B, which additionally incorporates postnatal variables and characterizes the full mechanistic perinatal risk trajectory. Binary and ordinal outcomes included DLS, PH, BPD, intraventricular hemorrhage (IVH), and neonatal death. Pairwise interaction models were additionally computed to identify cross-domain risk constellations. Results: Distinct predictor architectures emerged per outcome. Pulmonary hypoplasia was most strongly associated with temporal features of oligohydramnios—particularly the persistence and timing of SDP < 1 cm—rather than isolated measurements. For DLS, the antenatal model (Model A) achieved AUC 0.776, driven by gestational maturity and inflammatory status; surfactant administration—a postnatal variable reflecting therapeutic response rather than an antenatal risk factor—dominated only the mechanistic Model B. Neonatal death was driven by a combined profile of respiratory support burden, amniotic fluid persistence, and co-morbidity. IVH showed consistently high ordinal predictability (accuracy 0.863), with amniotic fluid dynamics and microbiological burden as leading contributors. BPD remained the least linearly separable endpoint across all configurations. Conclusions: Multi-domain machine learning reveals outcome-specific, cross-domain risk architectures following second-trimester PPROM that are invisible to conventional statistical models. Longitudinal amniotic fluid trajectory is the dominant antenatal determinant of structural pulmonary morbidity, while microbiological burden independently shapes neurological risk. These findings support prospective validation of integrated ML-based risk stratification tools for individualized antenatal counselling in this high-risk population. Full article

The global obesity epidemic is expanding at an alarming rate, posing significant health risks for women of reproductive age due to immediate pregnancy complications and adverse long-term effects on offspring. Consequently, several non-pharmacological strategies have been proposed to mitigate these impacts. Therefore, we hypothesized that the combined application of the probiotic Lacticaseibacillus rhamnosus GG (LGG) and enriched environment (EE) will result in improved metabolic and histopathologic findings within a model of maternal obesity, surpassing the efficacy of individual therapeutic strategies. Using nulliparous Wistar rats, LGG was administered before, during, and after gestation, while EE was implemented during pregnancy and lactation. LGG supplementation and an enriched environment separately improved blood triacylglycerols. The enriched environment was more effective in reducing the effects of maternal obesity, even lessening liver damage observed in obese subjects in the form of vacuolar infiltrates. The results obtained suggest a potential functional interaction in this combined model, and the findings indicate that LGG may have influenced the modulation of enriched environment effects on metabolic parameters. Diet, probiotic supplementation, and environmental setting during the perinatal period have specific effects on biochemical and tissular parameters, establishing their descriptive role as non-pharmacological intervention strategies and underscoring the need for mechanistic studies to elucidate the biological pathways underlying these effects. Full article

Background/Objectives: Minipuberty represents the second phase of physiological activation of the reproductive axis and may play a role in postnatal genital development. Its course has been shown to be affected by untreated or inadequately treated maternal hypothyroidism. The aim of the present study was to investigate minipuberty in the sons of women with euthyroid autoimmune thyroiditis during pregnancy. Methods: This prospective matched cohort study included three groups of apparently healthy infant boys. Two groups comprised the male offspring of levothyroxine-naive, euthyroid women with autoimmune thyroiditis: one group was unsupplemented, and the other received vitamin D and selenium supplementation. The control group consisted of boys born to healthy women. Salivary concentrations of testosterone, androstenedione, DHEA-S, estradiol, and progesterone, along with urinary FSH and LH levels, were assessed longitudinally over the first 12 months of life. These hormonal measurements were evaluated in relation to genital development, including testicular volume and penile length, which were recorded at each study visit. Results: Compared with the offspring of healthy mothers, sons of women with autoimmune thyroiditis who did not receive supplementation exhibited lower concentrations of LH and testosterone, without a distinct peak, while the duration of hormone detectability did not differ between the groups. These hormonal alterations were accompanied by reduced penile length, with no differences observed in testicular volume. This group also exhibited lower DHEA-S concentrations, whereas levels of other hormones were comparable. In contrast, in the group receiving vitamin D and selenium supplementation, the dynamics of hormonal changes and genital organ growth did not differ from those observed in the control group. LH concentrations were inversely correlated with thyroid peroxidase antibody titers, which were lower in the supplemented group. Conclusions: The findings indicate an altered course of minipuberty in the sons of women with euthyroid autoimmune thyroiditis during pregnancy and suggest a potential benefit of exogenous vitamin D and selenium supplementation in this population. 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: Assisted reproductive technology (ART) is increasingly utilized worldwide, and approximately 30% of ART pregnancies result in twin gestations. Chorionicity strongly influences perinatal risk, yet its specific impact on ART-conceived twins has not been systematically clarified. Objective: To compare obstetrical and neonatal outcomes in assisted ART-conceived monochorionic (MC) versus dichorionic (DC) twin pregnancies and evaluate the impact of chorionicity on maternal and perinatal outcomes. Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024600292). PubMed, Scopus, and Web of Science were searched through October 2024 for studies comparing obstetrical and neonatal outcomes in ART-conceived monochorionic and dichorionic twin pregnancies. Eligible studies were qualitatively synthesized. Results: Thirty-five studies comprising 15,648 ART-conceived twin pregnancies were included, including 371 monochorionic and 15,277 dichorionic pregnancies. MC pregnancies consistently demonstrated less favorable perinatal outcomes compared with DC pregnancies, including an earlier gestational age at delivery, increased prematurity, lower birth weight, and higher rates of perinatal mortality. By contrast, maternal complications, such as hypertensive disorders, gestational diabetes mellitus, PROM, and cesarean delivery, varied considerably across the studies without a consistent association with chorionicity. The baseline maternal characteristics were generally comparable between the groups. Conclusion: Monochorionicity in ART-conceived twin pregnancies is associated with increased adverse neonatal and perinatal outcomes, particularly prematurity and perinatal mortality, while maternal outcomes appear less clearly influenced by chorionicity. Standardized prospective studies are needed to further clarify the chorionicity-specific risks in ART twin pregnancies. Full article

Gestational diabetes mellitus (GDM), as one of the most common metabolic disorders occurring during pregnancy, represents a significant public health concern due to its rising prevalence and the numerous complications that can affect both the mother and the foetus. In recent years, there has been growing interest in the use of omics technologies, such as metabolomics and proteomics, in research on the pathogenesis and early detection of GDM. The aim of this paper was to summarise the current knowledge on metabolomic and proteomic changes observed in women with GDM and to assess the potential usefulness of these methods in identifying biomarkers of the disease. The narrative review was conducted in accordance with the PRISMA 2020 statement, using PubMed and Web of Science until 23 December 2025. The studies analysed show that GDM is associated with abnormalities in the metabolism of lipids, amino acids, carbohydrates and metabolites associated with the gut microbiota. The most commonly observed changes included: elevated levels of branched-chain amino acids, free fatty acids and purine metabolites, as well as changes in the metabolism of phospholipids and acylcarnitines. Multi-omics studies also indicate significant changes in plasma protein and lipid profiles. The data collected suggest that omics technologies may be a promising tool for identifying early biomarkers of GDM and for developing our understanding of the pathophysiological mechanisms of this condition. Nevertheless, further studies involving larger and more diverse patient populations are needed to confirm their diagnostic and clinical value. Full article

Background: Frozen embryo transfer (FET) use in assisted reproductive technology (ART) has increased globally, with multiple reviews linking FET—particularly medicated cycles—to higher risks of obstetric complications including hypertensive disorders of pregnancy (HDP). Given that HDP is a sex-specific risk factor for future cardiovascular disease (CVD), this study aimed to assess acute cardiovascular changes in medicated versus natural modified FET cycles. Methods: This was a prospective observational cohort study at a fertility centre in London. Patients were recruited from May 2021 to March 2022. Maternal demographics including age, body mass index, smoking status, ethnicity and parity were recorded. Cardiovascular parameters including blood pressure along with measures of left ventricular systolic and diastolic function, assessed by transthoracic echo, were analysed at baseline in the luteal phase of the preceding cycle and on the day of embryo transfer, in medicated and natural modified FET cycles. Repeat measures analysis of the cardiac variables for the two time points, comparing the two protocols after controlling for maternal demographics, was performed by linear mixed models. Results: Seventy-two healthy patients were included in the analysis; of those, 59 (82%) underwent the medicated protocol. For both protocols, after controlling for maternal demographic characteristics, the left atrial area significantly increased (p = 0.004) from baseline to embryo transfer with a mean difference of 0.98 (95% CI [0.33, 1.63]). When comparing the interaction between the protocols between the two time points, whilst no effect could be seen on haemodynamic variables or left ventricular diastolic/systolic function, medicated FET cycles were associated with a statistically significant improvement in mean average global longitudinal strain (GLS) (p = 0.024) with a mean difference of −2.24 (95% CI [−4.17, −0.31]), whereas natural modified cycles demonstrated a slight shift toward more positive strain values. Conclusions: In this cohort of healthy patients undergoing FET, both protocols were associated with a significant increase in left atrial area from baseline to embryo transfer possibly resulting from an increased preload due to progesterone administration. The improvement in left ventricular average GLS seen in medicated FET cycles may reflect protocol-related physiological effects, potentially mediated by sustained exogenous oestrogen exposure and its influence on vascular loading conditions and myocardial relaxation. Full article

Background/Objectives: The soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio is an established biomarker in the diagnosis of preeclampsia; however, its significance outside overt hypertensive disorders of pregnancy remains unclear. Emerging evidence suggests that angiogenic imbalance may reflect subclinical placental dysfunction even in otherwise low-risk pregnancies. To investigate associations between the sFlt-1/PlGF ratio and maternal and neonatal outcomes in a low-risk term obstetric population, beyond established diagnostic cut-offs. Methods: This prospective cohort study included 87 women with singleton term pregnancies. Serum sFlt-1 and PlGF concentrations were measured at hospital admission before delivery, and the sFlt-1/PlGF ratio was calculated. The primary outcome was estimated blood loss at delivery. Secondary maternal outcomes included postpartum hemoglobin decline, uterine atony, and fibrinogen concentration. Neonatal outcomes included birthweight, umbilical artery pH, and bilirubin concentration. Multivariable regression models were used to evaluate associations between the ln-transformed sFlt-1/PlGF ratio and outcomes after adjustment for prespecified maternal and obstetric covariates. Results: Each doubling of the sFlt-1/PlGF ratio was associated with greater estimated peripartum blood loss (+78.0 mL, 95% CI 42.1–113.9; p < 0.001), a larger postpartum hemoglobin decline (+0.078 g/dL, 95% CI 0.008–0.148; p = 0.030), lower fibrinogen concentration (−20.7 mg/dL, 95% CI −30.5 to −10.9; p < 0.001), and lower neonatal birthweight (−64.6 g, 95% CI −102.0 to −27.2; p = 0.001). No significant associations were observed for uterine atony, premature rupture of membranes, or umbilical artery pulsatility index above the 75th centile. Conclusions: In low-risk term pregnancies, higher sFlt-1/PlGF ratios were associated with greater estimated peripartum blood loss, lower fibrinogen concentrations, and lower neonatal birthweight. These findings support the hypothesis that variation in angiogenic balance may reflect subclinical placental dysfunction even in apparently uncomplicated pregnancies. Further prospective studies are needed to validate these exploratory observations and determine their clinical relevance. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) represents one of the most common pregnancy-related disorders and it is correlated to increased risks of adverse maternal and neonatal outcomes. The prognostic role of initial glycemic values in predicting neonatal hypoglycemia and other complications remains underexplored. Methods: This retrospective study analyzed 233 women diagnosed with GDM between 2018 and 2024. Participants were stratified into three risk groups based on diagnostic oral glucose tolerance test (OGTT) values: low-risk group (fasting plasma glucose [FPG] 92–100 mg/dL, 1 h < 180 mg/dL, 2 h < 153 mg/dL), intermediate-risk group (FPG 101–110 mg/dL or 1 h 180–190 mg/dL or 2 h 153–163 mg/dL), and high-risk group (FPG > 110 mg/dL or 1 h > 190 mg/dL or 2 h > 163 mg/dL). Neonatal hypoglycemia was defined as the primary outcome, whereas secondary outcomes comprised insulin requirements, continuous glucose monitoring (CGM) use, macrosomia, polyhydramnios, and perinatal complications. Results: Non-significant differences across groups were observed except for Caucasian predominance in the high-risk group. Hypoglycemia trended higher in intermediate- and high-risk groups (26% and 21% vs. 17%), as well as polyhydramnios (14.3% and 13.8% vs. 4.5%) without statistical significance. Overall metabolic control was excellent, with almost 70% of patients maintaining HbA1c values ≤ 5.5% throughout the pregnancy with early and limited use of insulin therapy (17.3%). Conclusions: Diagnostic OGTT stratification provides limited prognostic value in optimized GDM care with early CGM and insulin use. Although trends for hypoglycemia and polyhydramnios suggest potential utility, the excellent metabolic control likely flattened the differences between groups. Prospective trials with CGM metrics are needed to develop more refined risk models, potentially enabling a more personalized management. Full article

Introduction: Upper urinary tract infections (UUTIs) are among the most common serious infections during pregnancy and may be associated with maternal and fetal complications. The increasing prevalence of multidrug-resistant pathogens has led to the use of broader-spectrum antibiotics, including meropenem. However, data regarding the safety and efficacy of meropenem in pregnant women remain limited. The aim of this study was to evaluate the indications, efficacy, and safety of meropenem treatment in pregnant women with UUTIs and its impact on maternal and fetal outcomes. Methods: We conducted a retrospective study over a 12-year period including pregnant women hospitalized with UUTIs who received meropenem. The control group consisted of pregnant women with UUTIs who were treated with ceftriaxone during the same period. Results: Pregnant women treated with meropenem were more frequently diagnosed in the third trimester of pregnancy (p = 0.01) and were more often multiparous (p = 0.006). Sepsis and septic shock occurred significantly more frequently in the study group (p < 0.01), and multivariate analysis identified them as the main indications for meropenem administration (OR 10.54, 95% CI 3.30–33.70 for sepsis; OR 3.28, 95% CI 1.01–10.62 for septic shock). Patients in the study group had a higher rate of transfer to the obstetrics clinic (p = 0.032), a longer duration of antibiotic therapy (p = 0.031), and a longer hospital stay (p < 0.01). No maternal deaths were reported in either group. The rate of adverse pregnancy outcomes was similar between the two groups, except for the Apgar score, which was lower in the meropenem group (p = 0.007). Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens in both groups. Conclusions: Meropenem therapy in pregnant women with UUTIs was mainly indicated in cases of sepsis and septic shock and was associated with favorable maternal clinical evolution, even in patients with severe infections. The rate of adverse pregnancy outcomes was similar between the two groups, although a lower Apgar score was observed in the meropenem group; the severity of illness in the meropenem group should be considered when interpreting the lower Apgar scores. Further prospective multicenter studies are needed to better evaluate the safety and clinical effectiveness of meropenem during pregnancy. 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

Introduction: Pregnancy in women with end-stage kidney disease (ESKD) remains rare and high-risk, despite advancements in dialysis and supportive care. Using a nationwide database in South Korea, this study examined the maternal and neonatal outcomes among women undergoing maintenance hemodialysis, with a particular focus on dialysis modality and treatment patterns. Methods: This population-based retrospective cohort study utilized data from the Korean National Health Insurance Service database. The study included all live births between 1 January 2014 and 31 December 2022, linked to mothers who underwent hemodialysis at least twice per week during pregnancy. Results: Between 2014 and 2022, in the Republic of Korea, 31 live births were recorded among 29 women undergoing hemodialysis. The mean maternal age at delivery was 36.1 ± 4.94 years, and most patients had significant comorbidities, including hypertension (79.3%), and diabetes mellitus (48.3%). Cesarean section was the predominant mode of delivery (75.9%). Pregnancy-related complications included preterm delivery (48.4%), preeclampsia (16.1%), and gestational diabetes (16.1%). A total of 16.1% of the neonates had atrial septal defects. During the peripartum period, 93.1% of deliveries occurred at tertiary care centers, and trimester-wise escalation in dialysis frequency was observed. Conclusions: This study provided real-world data on pregnancy-related outcomes among women with ESKD undergoing maintenance dialysis in Korea. Given the rarity of this clinical condition, our findings may serve as a valuable reference for the management of pregnant women with ESKD. Full article