Poster Session 4 : Friday, 9 October 2026   15:45 – 17:00

Manal Massalha; Gharid Nourallah Bekdache; Bryon DeFrance; Kinga Malinowski; Jon F. Barrett; Eran M. Ashwal McMaster University, Hamilton, Canada Objective : To develop and validate a clinical prediction model estimating the probability of successful vaginal delivery in patients with Large‐for‐gestational‐age (LGA) fetuses who undergo a trial of labor, using routinely available clinical parameters. Study Design : Retrospective single‐center cohort of singleton LGA pregnancies ≥34 weeks undergoing trial of labor (2011–2024). A multivariable logistic regression model predicting vaginal delivery was developed (2018–2024) using maternal and obstetric predictors with multiple imputation. Model performance was evaluated by bootstrap internal validation, temporal testing, and external validation, assessing discrimination, calibration, and overall accuracy. Results : Among 876 patients in the development cohort, 668 (76.3%) achieved vaginal delivery. Independent predictors in multivariable analysis included: multiparous with prior vaginal delivery versus nulliparous (adjusted odds ratio [aOR] 16.47, 95% CI 10.44–25.97, p  < 0.001), pre‐gestational diabetes (aOR 0.42, 95% CI 0.23–0.78, p  = 0.006), induced labor (aOR 0.55, 95% CI 0.36–0.84, p  = 0.005), maternal age (aOR 0.94 per year, 95% CI 0.91–0.98, p  = 0.003), and gestational age (aOR 0.84 per week, 95% CI 0.73–0.98, p  = 0.025). Notably, birth weight percentile was not significant (aOR 0.98, p  = 0.60). Model discrimination was excellent: apparent C‐statistic 0.847 (95% CI 0.817–0.877), optimism‐corrected 0.837, temporal validation 0.853, external validation 0.737. Calibration was excellent (Hosmer‐Lemeshow p  = 0.933, slope 1.004). Decision curve analysis demonstrated net benefit across threshold probabilities 0.30–0.95. Among vaginal deliveries, LGA‐associated adverse outcomes included shoulder dystocia (16.3%), severe perineal trauma (8.8%), brachial plexus injury (0.6%), and neonatal bone fracture (0.3%). Conclusion : This validated model accurately predicts successful vaginal delivery in LGA pregnancies undergoing labor. Prior vaginal delivery is the strongest predictor, while birth weight percentile adds little. It supports individualized counseling and shared decision‐making.

Manal Massalha 1 ; Misgav Rottenstreich 2 ; Bryon DeFrance 1 ; Kinga Malinowski 1 ; Jon F. Barrett 1 ; Eran M. Ashwal 1 1 McMaster University, Hamilton, Canada; 2 Shamir Medical Center, Zerifin, Israel Objective : To evaluate whether the anemia‐derived middle cerebral artery peak systolic velocity (MCA‐PSV) ≥1.5 5 multiples of the median (MoM) threshold predicts adverse neonatal outcomes in non‐anemic late‐onset fetal growth restriction (FGR). While elevated MCA‐PSV occurs in FGR via cerebral vasodilation, its prognostic value in this context remains unclear. Study Design : Retrospective cohort of singleton late‐onset FGR pregnancies (Delphi criteria, ≥32 weeks) at Canadian tertiary centers (2017–2024), excluding anemia, major anomalies, and chromosomal abnormalities. MCA‐PSV was classified as elevated (≥1.5 MoM) or normal, and evaluated against a composite neonatal outcome (cord pH <7.10, Apgar <7, emergency cesarean, RDS, phototherapy, hypoglycemia, or neonatal death) using test characteristics, AUC, and multivariable analysis. Results : Among 910 eligible cases (mean gestational age 36.7 ± 1.6 weeks), 63 (6.9%) had MCA‐PSV ≥1.5 MoM. The composite adverse outcome occurred in 50.8% of cases with elevated MCA‐PSV compared to 47.2% with normal MCA‐PSV (unadjusted OR 1.15, 95% CI 0.69–1.92, p  = 0.603), representing an absolute difference of only 3.6%. Test characteristics were very poor: sensitivity 6.0%, specificity 93.9%, positive likelihood ratio 0.99, negative likelihood ratio 1.00. Adding MCA‐PSV to models that included gestational age and standard Doppler parameters provided minimal additional discrimination (ΔAUC 0.004, p  = 0.024). In multivariable analysis, elevated MCA‐PSV was associated with a marginally significant inverse relationship to adverse outcomes (aOR 0.52, 95% CI 0.28–0.98, p  = 0.043). Among individual outcomes, only respiratory distress syndrome was more common with elevated MCA‐PSV (14.3% vs 5.9%, p  = 0.016). Conclusion : MCA‐PSV ≥1.5 MoM does not predict adverse outcomes in late‐onset FGR (without anemia). It showed no diagnostic value (LR + 0.99; LR – 1.00), negligible model improvement (ΔAUC 0.004), and minimal real‐world outcome differences despite a statistical association. The anemia‐derived threshold should not guide surveillance or delivery timing in this population.

Paola M. Calvo 1 ; Arlene Calvo 2 ; Humberto Lopez Castillo 3 1 Universidad Latina de Panamá, Panama city, Panama, Panama; 2 University of South Florida, Panama City, Panama; 3 University of Central Florida, Orlando, FL Objective : To analyze maternal mortality ratios (MMR) across Latin America and the Caribbean (LAC) during a 10‐year pooled period by estimating intraregional heterogeneity. Study Design : Descriptive analysis of LAC maternal mortality between 2013–2023. Countries with at least five years of reported maternal deaths and live births were included, based on data extracted from the PAHO Core Indicators Portal. Maternal deaths and live births were aggregated across the 10‐year period to calculate pooled MMRs using the standard formula, with 95% confidence intervals. Countries were grouped into tertiles of high‐, medium‐, and low‐MMRs to compare patterns and explore factors contributing to regional disparities. Results : 30 LAC countries/territories were included. MMRs ranged from 13.83 (Trinidad and Tobago) to 229.1 (Saint Kitts and Nevis) with a 72.6 mean, 65.35 median, and 177.9 SD. Countries with high MMR were mostly smaller Caribbean states. Countries with the lower MMR tertiles were mostly located in South America. Conclusion : Small countries, mostly from the Caribbean region, present elevated ratios, depicting smaller populations with limited resources. Larger South American countries had lower MMRs and presented more robust health systems. Reducing maternal mortality disparities in LAC countries demands sustained political commitment, strengthened health systems, and equitable resource distribution.

Paola M. Calvo 1 ; Arlene Calvo 2 1 Universidad Latina de Panamá, Panama city, Panama, Panama; 2 University of South Florida, Panama City, Panama Objective : To analyze the systematic impediments, including geographical isolation and personnel distribution in urban cities compared to indigenous Comarcas in Panama. Study Design : A cross‐sectional, retrospective study was carried using statistics from the National Institute of Statistics and Census (INEC) for the latest published report from 2024.We compared maternal mortality rates of urban provinces vs rural indigenous comarcas, similar to reservations. The analysis focused on place of death, access to prenatal care, and direct compared to indirect obstetric causes to identify systemic gaps. Results : In 2024 there were 31 confirmed maternal deaths in Panama. Of the 31 deaths 19 occurred in the indigenous comarcas(13 in Ngäbe‐Buglé and 6 in Guna Yala communities), this represents 61.3% of maternal deaths in Panama. 20% of indigenous women had zero prenatal check‐ups and 43% had only 1 to 3 check‐ups, a total of 64.5%of deaths occurred within health facilities, with 61.3% attributed to direct obstetric causes such as hemorrhage and eclampsia. Conclusion : The high incidence of maternal moratlity rates in medical settings reveals the “medical desserts”in the comarcas. These parts of the country suffer from a lack of resolutive capacity. This is do insufficient blood banks and specialized personnel like obstetrics and gynecology. The data clearly reveals that maternal mortality in Panama is not just a geogrpahic issue but a systematic failure, where the healthcare architecture fails to deliver life‐saving intervention even when the patient reaches the facility.

Maia Brik 1 ; Miguel Sánchez‐Polan 2 ; Cristina Silva 3 ; Paloma Hernando Lopez de la Manzanara 4 ; Maria Angeles Diaz Blanco 5 ; Aranzazu Martin Arias 6 ; Joaquin Temprado 7 ; Carmen Fortuny 7 ; Ruben Barakat 3 1 Hospital Vall d´Hebron Institute of Research, Barcelona, Spain; 2 Universidad de Comillas, Madrid, Spain; 3 Universidad Politécnica de Madrid, Madrid, Spain; 4 Hospital Puerta de Hierro, Madrid, Spain; 5 Hospital Severo Ochoa de Leganés, Leganés, Spain; 6 Hospital de Torrejón, Madrid, Spain; 7 Hospital Vall d´Hebron, Barcelona, Spain Objective : Health Related Quality of Life (HRQoL) refers to how a pregnant person perceives their physical, mental, and social well‐being, and it is a predictor of poor maternal and infant outcomes. The aim of the research is to investigate whether a physical activity program during pregnancy influences the HQQoL. Study Design : Study design: a secondary analysis of a two‐branch multicenter randomized controlled trial was performed in five recruiting hospital centers in Spain. A population of 556 singleton pregnant individuals with no medical contraindications for exercising during pregnancy, was included. Intervention included a moderate intensity physical activity program from 13–16 weeks to 39 weeks following Barakat´s Model (aerobic, strength, coordination, balance and pelvic floor), three weekly hybrid online and on‐site sessions. A comparison analysis of both groups at 34–36 weeks, and 6–8 weeks postpartum was performed. The main outcome measures included HRQoL (SF‐12 questionnaire: Physical, PC, and Mental component, MC) and the secondary outcomes were sleep quality (PSQI questionnaire), disability (MODQ questionnaire) and obstetric outcomes (preterm birth, low birth weight and cesarean section). Results : HRQoL scores were similar among groups. However, there was an improvement in the quality of sleep at the end of the pregnancy in the intervention group compared to the control (6.1 ± 3.1 vs. 7.2 ± 3.5, p  = 0.015), and a trend of better perception of disability (12.6 ± 13.6 vs. 16.6 ± 15.2, p  = 0.056) during postpartum. Participants with program adherence above 80% showed better PC Health‐Related Quality of Life compared to lower adherences (51.3 ± 7.7 vs. 42.7 ± 14.6, p  = 0.029) during postpartum. Conclusion : A moderate intensity physical activity program improves the quality of sleep and may affect the disability perception. In addition, when increased adherence to the program, it improves the PC Health‐Related Quality of Life during postpartum.

Thomas Hanton 1 ; Basia Chmielewska 2 ; Asma Khalil 3 1 St George's University Hospitals NHS Foundation Trust, St George's University Hospitals NHS Foundation Trust, United Kingdom; 2 St George's University Hospitals NHS Foundation Trust, London, United Kingdom; 3 City St George's, University of London, London, United Kingdom Objective : To determine whether area‐level social deprivation is associated with uteroplacental vascular resistance across pregnancy, assessed by mean uterine artery pulsatility index (UtA‐PI), and to assess the association of gestational age, ethnicity and hypertensive disorder of pregnancy (HDP) status. Study Design : We performed a retrospective cohort study of 21,581 singleton pregnancies delivering at a large UK tertiary maternity unit between January 2020 and January 2025. Women were routinely offered first‐trimester dating (T1), second‐trimester anomaly (T2) and third‐trimester growth scans (T3). Mean UtA‐PI was analysed at each timepoint and Index of Multiple Deprivation (IMD) deciles were calculated from postcodes collected at T1. Prespecified secondary analyses examined HDP status and ethnicity. Results : 14,108 women had UtA‐PI recorded at all three scans and a valid postcode. Mean UtA‐PI declined across gestation (1.502 at T1, 0.898 at T2 and 0.664 at T3), consistent with physiological reduction in uteroplacental resistance. There was little evidence that social deprivation materially influenced UtA‐PI at any trimester after accounting for gestational age. At T2, each increase in IMD decile was associated with only a 0.01‐unit difference in UtA‐PI, suggesting a statistically detectable but clinically small effect. In contrast, ethnicity showed a more consistent association: compared with White women, Black women had higher adjusted mean UtA‐PI at T1, T2 and T3, with similar but smaller differences in South Asian women. Women who developed HDP had higher blood pressure throughout pregnancy, but deprivation gradients in UtA‐PI remained modest. Conclusion : In this large longitudinal cohort, social deprivation was not associated with a clinically meaningful difference in UtA‐PI across pregnancy. This suggests that socioeconomic inequalities in HDP may not primarily operate through altered uteroplacental Doppler resistance, and that other pathways may be more important. The persistent ethnic differences in UtA‐PI warrant further investigation.

Thomas Hanton 1 ; Basia Chmielewska 2 ; Asma Khalil 3 1 St George's University Hospitals NHS Foundation Trust, St George's University Hospitals NHS Foundation Trust, United Kingdom; 2 St George's University Hospitals NHS Foundation Trust, London, United Kingdom; 3 City St George's, University of London, London, United Kingdom Objective : To assess the association between socioeconomic deprivation and placental insufficiency in a routine obstetric population. Study Design : In this retrospective cohort study, we analysed 14,108 singleton pregnancies who delivered at a large UK tertiary maternity unit between January 2020 and January 2025 and had three routine ultrasound scans and postcodes recorded. Deprivation was classified using the Index of Multiple Deprivation and grouped as Q1–2, Q3 and Q4–5. The primary outcome was a composite of preterm birth <37 weeks, fetal growth restriction <3rd centile, hypertensive disorders of pregnancy and stillbirth. Logistic regression adjusted for maternal age and ethnicity. Results : Composite placental insufficiency occurred in 15.1% of women in Q1–2, 13.0% in Q3 and 11.5% in Q4–5. Compared with Q4–5, women in Q1–2 had increased odds of the composite outcome (aOR 1.21, 95% CI 1.07–1.37; p  = 0.003) and HDP (aOR 1.40, 95% CI 1.12–1.75; p  = 0.003). Conclusion : Greater socioeconomic deprivation was associated with increased odds of placental insufficiency, particularly HDP.

Itamar Gilboa 1 ; Daniel Gabbai 2 ; Emmanuel Attali 2 ; Yariv Yogev 2 ; Anat Lavie 2 1 Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2 Lis Maternity & Women's Hospital, Tel‐Aviv Sourasky Medical Center, Tel‐Aviv, Israel, Tel AVIV, Israel Objective : To evaluate whether vacuum‐assisted delivery (VAD) independently increases the risk of maternal postpartum infection, given conflicting evidence and ongoing debate regarding the need for prophylactic antibiotics. Study Design : retrospective cohort study was conducted at a tertiary university‐affiliated center (2011–2023). Singleton vaginal deliveries ≥37 weeks were included. VAD cases were compared with spontaneous vaginal deliveries (SVD). To minimize confounding, cases with intrapartum fever, prolonged rupture of membranes (≥24 h), GBS colonization, intrapartum antibiotics, manual placental removal, severe perineal tears, or postpartum prostaglandin use were excluded. Postpartum infection was defined as fever ≥38°C within 2–48 hours requiring antibiotic treatment. Multivariable logistic regression was used to assess independent associations. Results : Among 78,288 eligible deliveries, 6137 (8.0%) were VAD. Postpartum infection was more frequent in the VAD group compared with SVD (0.7% vs 0.2%, p  < 0.001). Women undergoing VAD had higher rates of nulliparity, prior cesarean delivery, IVF, higher BMI, labor induction, epidural use, PROM, and prolonged labor stages. After adjustment for confounders, VAD remained independently associated with postpartum infection (adjusted OR 2.8, 95% CI 1.5–5.3, p  = 0.001; Table 1. Conclusion : VAD is independently associated with an increased risk of postpartum infection, despite overall low absolute rates. These findings support consideration of a risk‐based approach to antibiotic prophylaxis following operative vaginal delivery rather than routine administration.

Anne Pinton 1 ; Catherine Deneux‐Tharaux 2 ; Gilles Kayem 1 1 Hôpital Trousseau, Paris, France; 2 Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics, Obstetric Perinatal and Paediatric Life Course Epidemiology Team OPPaLE, iWISH, F‐75004 Paris, France, Paris, France Objective : The objective of this study was to assess the incidence and the risk factors of severe postpartum hemorrhage in women with posterior low‐lying placenta and prior cesarean without prenatal suspicion of placenta accreta spectrum. Study Design : The study population is derived from the PACCRETA population‐based study conducted in the 176 maternity units of 12 French regions from November 2013 through October 2015. All women with posterior low‐lying placenta and prior caesarean without prenatal suspicion of PAS were included in this analysis. The main outcome measure was a composite criterion of severe PPH defined by either estimated blood loss of 1500 ml or more, transfusion of 4 or more units of packed red blood cells, embolization, or surgical treatment. Results : Of the 520,114 women comprising the source population, 75 (0.14 per 1000 women; 95% CI, 0.11–0.18) met the inclusion criteria. Among these women, severe PPH occurred in 9 i.e severe PPH incidence of 9.3% (95% CI, 4.2–18.9). Unsuspected PAS was diagnosed at delivery in 4 women of the study population (5.3%). Without these cases of PAS, severe PPH incidence was 7.0% (95% CI, 2.6–16.3). Factors associated with severe PPH were unsuspected PAS diagnosed at delivery (severe PPH incidence of 50% vs 7%, p  = 0.04) and placenta‐os distance 1–9 mm compared to 10–19 mm (severe PPH incidence of 19% vs 0%, p  = 0.03). Conclusion : About 1 in 11 women with posterior low‐lying and prior cesarean without antenatal suspicion of PAS has severe PPH. Factors associated with severe PPH are unsuspected PAS diagnosed at delivery and 1–9 mm versus 10–19 mm placenta‐os distance.

Anne Pinton 1 ; Felicia Joinau‐Zoulovits 2 1 Hôpital Trousseau, Paris, France; 2 Inserm (the French National Institute of Health and Medical Research), Paris, France Objective : To assess the medical and psychosocial follow‐up, as well as obstetrical, neonatal complications and postpartum length of hospital stay, among women aged 49 years and older compared to women aged 25–35. Study Design : We conducted a retrospective, observational, monocentric, case‐control study between 2016 and 2023 in a level III maternity unit. Women aged 49 years and older who gave birth were compared with a matched control group aged 25–35 years using a 1:2 ratio. Data was collected on demographics, pregnancy monitoring, psychosocial support, obstetric complications, delivery outcomes, neonatal issues and prolonged postpartum hospitalization. Results : The study included 39 women aged 49 years and older and 78 controls. Advanced maternal age was significantly associated with higher rates of assisted reproductive technology (97% vs. 5%, p  < 0.01), single parenthood (33% vs. 3%, p  < 0.01), and psychosocial support during pregnancy (33% vs. 8%, p  < 0.01). Obstetrical complications were significantly more frequent among women aged 49 years and older, including higher rates of preeclampsia (28% vs. 4%, p  < 0.01), caesarean section (71% vs. 14%, p  < 0.01) and postpartum hemorrhage (51% vs. 15%, p  < 0.01). After adjustment, maternal age above 49 years remained strongly associated with prolonged postpartum hospitalization (aOR 4.24, 95% CI 1.14–17.4, p  < 0.01) as emergency caesarean (aOR 6.17, 95% CI 1.39–31.8, p  = 0.01) and preterm delivery (aOR 5.88 95% CI 1,41–33,3, p  = 0.02). Conclusion : Pregnancy at advanced maternal age (≥49 years) is associated with greater medical and psychosocial needs and increased obstetrical complications, highlighting the need for tailored prenatal and postnatal care.

Sapir Ellouk 1 ; Tamar Wainstock 2 ; Eyal Sheiner 3 1 Soroka University Medical Center, Beersheba, Israel; 2 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel; 3 Soroka University Medical Center, Beer Sheva, Israel Objective : Antenatal corticosteroids (ACS) are widely used to accelerate fetal lung maturity and reduce neonatal morbidity and mortality in the setting of anticipated preterm birth. Emerging evidence has raised concerns about potential risks when exposure occurs in pregnancies that ultimately result in term delivery. Prior studies have reported associations with small for gestational age and neonatal hypoglycemia; however, data on long‐term outcomes in term‐born children are limited. This study aimed to examine the association between ACS exposure and long‐term malignancy risk in term‐born children. Study Design : We conducted a population‐based retrospective cohort study of singleton term deliveries from 1998 to 2021. Long‐term malignancy outcomes were compared between term‐born offspring exposed to ACS before 34 weeks of gestation and unexposed offspring, using integrated community and hospitalization databases. Cumulative incidence was evaluated using Kaplan–Meier survival analysis, and Cox proportional hazards models were applied to adjust for potential confounders. Results : Among 182,626 term deliveries, 2093 offspring (1.1%) were exposed to antenatal corticosteroids (ACS) before 34 weeks of gestation. Overall malignancy incidence per 1000 person‐years and cumulative incidence did not differ significantly between the exposed and unexposed groups (log‐rank p  = 0.111; Figure, Table). However, analysis of specific tumor types revealed a higher incidence of adrenal tumors among ACS‐exposed offspring ( p  = 0.002; Table). After adjusting for maternal age, gestational age, cesarean delivery, hypertensive disorders, and diabetes mellitus, ACS exposure was not significantly associated with overall malignancy morbidity (adjusted hazard ratio [aHR], 1.36; 95% CI, 0.91–2.04; p  = 0.132). Conclusion : Antenatal corticosteroid exposure before 34 weeks of gestation was not associated with an increased risk of overall malignancy in term offspring after adjustment for confounders.

Lucy A. Bartho 1 ; Jemima Seager 1 ; Susan P. Walker 2 ; Tuong‐Vi Nguyen 1 ; Stephen Tong 2 ; Tu'uhevaha J. Kaitu'u‐Lino 1 1 University of Melbourne, Melbourne, Australia; 2 University of Melbourne Department of Obstetrics, Gynaecology and Newborn Health, Melbourne, Australia Objective : Preeclampsia is a pregnancy complication caused by placental dysfunction. Gremlin 2 (GREM2) is a secreted protein essential for organ development. The role of GREM2 in the placenta and preeclampsia remains unknown. This study aimed to assess GREM2 as a potential biomarker for preeclampsia and characterise its function in the placenta. Study Design : Maternal plasma and placentas were collected from women with early‐onset preeclampsia (< 34 weeks’ gestation), at 36 weeks’ gestation prior to diagnosis of term preeclampsia. GREM2 concentration was measured in plasma by ELISA, and GREM2 mRNA and protein expression were measured in placental tissue by RT‐qPCR and ELISA, respectively. Human trophoblast stem cells (hTSCs) were differentiated into syncytiotrophoblast cells over 96 hours to assess changes in GREM2 expression during differentiation. Functional studies involved overexpression and knockdown of GREM2, and measurement of anti‐angiogenesis, hypoxia and GREM2 associated genes. Results : Circulating GREM2 was significantly elevated in 42 patients with early‐onset preeclampsia (< 34 weeks’ gestation, p  < 0.0001) compared to 22 controls. GREM2 was not altered in plasma collected at 36 weeks’ gestation prior to preeclampsia diagnosis at term ( n  = 28 vs n  = 92). GREM2 mRNA ( p  < 0.0001, preeclampsia, n  = 79 vs control, n  = 18) and protein ( p  = 0.002, preeclampsia n  = 43 vs control, n  = 20) expression were increased in placentas from patients with early‐onset preeclampsia. In hTSCs, GREM2 mRNA expression was significantly increased during differentiation into syncytiotrophoblasts ( p  = 0.04). GREM2 overexpression reduced expression of the antioxidant molecule thioredoxin in syncytiotrophoblasts (1200 pg/mL, p  = 0.03), while GREM2 knockdown decreased cytotrophoblast marker CDH1 ( p  = 0.02). Conclusion : GREM2 is differentially expressed in preeclampsia, with elevated circulating and placental levels in early‐onset disease. GREM2 is expressed in syncytiotrophoblasts and may regulate antioxidant defences in the placenta. Collectively, these findings give insight into GREM2 as a potential biomarker and its function in the placenta.

Reid Rebinsky; Christopher M. Nash; Jocelyn Stairs Dalhousie University, Halifax, Canada Objective : To compare the risk of postoperative surgical site infection with the use of cyanoacrylate glue vs. subcuticular suture alone during skin closure at the time of cesarean section. Secondary objectives included comparing the risk of wound complications including hematoma, seroma, and skin separation between groups. Study Design : We performed a prospectively registered systematic review and meta‐analysis of randomized controlled trials and cohort studies published from database inception until October of 2025. Cochrane Library, MEDLINE, EMBASE and Clinicaltrials.gov databases were searched. Two independent reviewers screened articles for eligibility. We included studies comparing surgical site infection in patients undergoing a transverse incision cesarean section who had received cyanoacrylate glue as an adjuvant to subcuticular skin closure vs. those who had received subcuticular suture alone. Random effects meta‐analyses were used to estimate risk ratios (RR) and 95% confidence intervals (CI). Statistical heterogeneity was estimated using the I 2 statistic. The Cochrane risk of bias tool (RoB 2.0) and Newcastle‐Ottawa quality assessment scales were used to assess the included studies for bias. Results : 2143 articles were screened for eligibility and 8 peer‐reviewed studies were included. 2005 participants were included with 1079 receiving cyanoacrylate glue and 926 receiving suture alone. There was a decreased risk of surgical site infection after cesarean section among those who received glue (RR 0.60; 95% CI [0.37, 0.97]) compared to suture alone. There was no difference in risk of hematoma or seroma (RR 2.34; 95% CI [0.67, 8.18]) or in risk of wound separation (RR 0.72; 95% CI [0.51, 1.01]) between groups. Conclusion : Use of cyanoacrylate glue as an adjuvant to subcuticular skin closure at the time of cesarean section is associated with a decreased risk of surgical site infection compared to suture alone. Further research is required to assess whether using glue is a cost‐effective strategy to reduce surgical site infection.

Lucrezia Viscioni 1 ; Agnese Caneschi 2 ; Chiara Lubrano 2 ; Ottavio Cassardo 2 ; Michele Orsi 2 ; Elisa Sabattini 1 ; Federica Locati 3 ; Valentina Romagnoli 4 ; Marina Tartarone 4 ; Martina Zoppetti 4 ; Irene Cetin 3 ; Francesca Parisi 3 On behalf of Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italia 1 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 2 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; 3 S. C. Ostetricia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; 4 Università degli Studi di Milano, Milano, Italy Objective : To determine whether early maternal steroid hormone profiles are associated with uterine vascular resistance, placental vascularization, and maternal cardiovascular adaptation in pregnancy. Study Design : Prospective cohort study including healthy women with spontaneous pregnancies. Maternal serum steroid hormones were measured at 5–7 weeks’ gestation. Principal component analysis (PCA) identified two endocrine profiles. Uterine artery pulsatility index (UtA‐PI) was assessed at 11–13 weeks. At 26 weeks placental vascularization was evaluated using 3D vascular index (VI), angiogenic balance by sFlt1/PlGF ratio and maternal hemodynamics using Ultrasonic Cardiac Output Monitor (USCOM). Results : Among 46 participants, two endocrine profiles explained 39.3% of variance: androgenic/luteal profile (high 17‐hydroxyprogesterone, androstenedione, testosterone) and estrogenic–glucocorticoid profile (high cortisol, cortisone, estradiol). Two hemodynamic patterns at 26 weeks explained 66.7% of variance: hypodynamic (high vascular resistance, low cardiac output) and hyperdynamic (low resistance, intermediate output). Androgenic/luteal profile is associated with higher UtA‐PI at 12 weeks (β 0.18, 95% CI 0.001–0.36) and, at 26 weeks increased placental VI (β 7.59, 95% CI 0.32–15.50), lower cardiac output (β −5.39, 95% CI −10.8 to −0.02) and lower hyperdynamic scores (β −0.33, 95% CI− 0.65 to −0.002). Estrogenic–glucocorticoid profile is associated with higher placental VI (β 9.05, 95% CI 1.25–16.85) and lower sFlt1/PlGF ratio (β −1.76, 95% CI −3.58 to −0.05). Conclusion : Androgenic/luteal profile is associated with higher early uterine vascular resistance and a mid‐gestation phenotype with increased placental vascularization but reduced cardiac output, suggesting compensatory or inefficient angiogenesis. Estrogenic–glucocorticoid profile is associated with increased placental vascularization and a more favorable angiogenic balance. These findings indicate that early endocrine milieu critically shapes uteroplacental vascular development and maternal cardiovascular adaptations.

Matthew D. Mitts; Lisbet S. Lundsberg; Colleen Sinnott; Caitlin Partridge; Jennifer F. Culhane Yale University, New Haven, CT Objective : Breastfeeding (BF) is associated with improved maternal cardiometabolic outcomes, but its relationship with early postpartum (PP) readmission remains poorly understood. We examined whether infant feeding type during the delivery admission is associated with hypertension‐ (HTN) and diabetes‐related (DM) hospital readmission within 6 weeks PP. Study Design : We performed a retrospective cohort study of all singleton, term deliveries in a hospital system from 2014–2024. Infant feeding recorded in the electronic health record during delivery admission hospitalization was categorized as BF (>90% breastfed) or mixed/formula feeding (MF) (≤90% breastfed). Neonates with feeding data outside minimum bounds or admitted to the NICU were excluded. Outcomes were HTN‐related inpatient readmission (IR) or emergency department readmission (ED) and DM‐related IR or ED within 6 weeks PP. Bivariate analyses identified variables ( p  < 0.05) for inclusion in multivariable logistic regressions. Results : Among 97,277 deliveries, 48.6% were BF, and 51.4% MF. Patient attributes differed significantly by feeding type (Table 1). MF was associated with higher IR (1.6% vs 0.8%) and ED readmission rates (1.5% vs 0.7%) compared with BF (Table 1). In logistic regression models (Table 2), crude analyses showed MF was associated with higher odds of HTN‐IR (OR 2.06, 95% CI 1.81–2.33), HTN‐ED (OR 2.13, 95% CI 1.87–2.43), DM‐IR (OR 4.29, 95% CI 2.61–7.05), and DM‐ED (OR 2.75, 95% CI 1.91–3.95). After multivariable adjustment, MF remained associated with HTN‐IR (aOR 1.21, 95% CI 1.06–1.39) and HTN‐ED (aOR 1.23, 95% CI 1.06–1.43), but not DM‐IR (aOR 1.27, 95% CI 0.74–2.16) or DM‐ED (aOR 0.96, 95% CI 0.63–1.45). Conclusion : Infant feeding during the delivery admission is associated with early PP readmission, with a persistent association for HTN‐related outcomes after adjustment. Infant feeding type may serve as an easily identifiable marker of PP HTN risk, with potential utility for early risk stratification.

Matthew D. Mitts; Lisbet S. Lundsberg; Colleen Sinnott; Caitlin Partridge; Jennifer F. Culhane Yale University, New Haven, CT Objective : Breastfeeding (BF) is associated with improved maternal outcomes, but its relationship with early postpartum (PP) readmission remains poorly characterized. We evaluated whether infant feeding type during the delivery admission is associated with maternal PP readmission within 6 weeks. Study Design : We performed a retrospective cohort study of all singleton, term deliveries in a hospital system from 2014–2024. Infant feeding documented in the EMR was categorized as BF (>90% breastfed), formula feeding (FF) (>90% formula) or mixed feeding (MF). Neonates where recorded feeds were outside minimum bounds or admitted to the NICU were excluded. The primary outcome was any inpatient readmission or emergency department (ED) readmission within 6 weeks PP. Secondary outcomes included breast infection‐related readmissions, as well as readmissions excluding those associated with breast infection. Bivariate analyses identified variables ( p  < 0.05) for inclusion in multivariable logistic regressions. Crude and adjusted odds ratios (OR) are presented. Results : Among 97,277 deliveries, 49% were BF, 39% MF, and 12% FF. Patient attributes differed significantly by feeding type (Table 1). The overall readmission rate for any reason was 1.7%. This rate was 4.7%, 7.8%, and 9.5% for BF, MF and FF respectively. In multivariable logistic regression (Table 2), BF was associated with lower odds of readmission for any reason compared with FF (aOR 0.80, 95% CI 0.73–0.86), whereas there was no difference between BF and MF (aOR 0.98, 95% CI 0.91–1.06). BF was associated with higher odds of breast infection related readmissions (aOR 1.73, 95% CI 1.17–2.57). After excluding breast infection encounters, the protective effect of BF compared to FF on readmission strengthened (aOR 0.76, 95% CI 0.70–0.83). Conclusion : BF during delivery hospitalization was associated with lower 6‐week PP readmissions for any reason but higher rates of breast infection related readmissions. Excluding breast infection related readmissions, the protective effect of BF for readmission for any reason within 6 weeks PP strengthened.

Niranjana Balu 1 ; Julia Dahlke 2 ; Todd R. Lovgren 3 ; Douglas Burgess 2 ; Joshua Dahlke 3 1 University of Nebraska Medical University (UNMC) ‐ Omaha, NE ‐ 4111 Dewey AveOmahaOmaha, NE 68198UNITED STATES ‐ Omaha, NE, Omaha, NE; 2 University of Missouri Kansas City College of Medicine, Department of Psychiatry, Kansas City, MO; 3 Nebraska Methodist Hospital and Perinatal Center, Department of Maternal‐Fetal Medicine, Omaha, NE Objective : To determine similarities and differences among guidelines (ACOG, SOGC, BJOG, SAMHSA, WHO, NICE) and assess strength of evidence of references cited for the definition, screening, antepartum/postpartum treatment, and breastfeeding recommendations for opioid use disorder (OUD) in pregnancy. Study Design : We performed a descriptive analysis comparing guidelines on OUD in pregnancy from six national and international organizations. Results : All guidelines recognized OUD during pregnancy as a significant health concern. Universal screening was recommended across guidelines. Screening tools include questionnaires, brief interventions, and psychosocial assessments. Obstetric guidelines (ACOG, SOGC, BJOG) outlined the importance of multidisciplinary care teams. All guidelines endorsed opioid agonist therapy and discouraged withdrawal during pregnancy, with SAMHSA providing the most guidance. Postpartum care emphasized continuity of treatment, highlighting the vulnerability of relapse. All guidelines except NICE addressed neonatal abstinence syndrome and endorsed standardized surveillance and treatment protocols in the immediate neonatal period. Breastfeeding was supported stable on agonist therapy, with WHO promoting the benefits of breastfeeding. (Table 1). Our analysis of references cited in each guideline is notable for broad and distinct bodies of evidence. We observed minimal overlap in primary research studies or systematic reviews across guidelines, with only one of the sixty‐three RCT's referenced across all 6 guidelines. (Table 2). Conclusion : There is broad consensus on clinical management among guidelines, with differences reflecting regional healthcare systems and policy priorities. The heterogeneity of references highlights the difficulty in conducting randomized controlled trials with guidelines primarily citing observational studies and clinical reviews. Guideline congruency may improve policy development, reduce variation in care, improve access to treatment, and promote equitable maternal and neonatal outcomes across this at‐risk population.

Felicia Joinau‐Zoulovits 1 ; Catherine Deneux‐Tharaux 2 ; Konstantinos Chatzistergiou 2 ; Agnès Dechartres 3 ; Elie Azria 2 1 Inserm (the French National Institute of Health and Medical Research), Paris, France; 2 Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics, Obstetric Perinatal and Paediatric Life Course Epidemiology Team OPPaLE, iWISH, F‐75004 Paris, France, Paris, France; 3 Sorbonne University, Pierre Louis Institute of Epidemiology and Public Health, Inserm UMR 1136, Department of Public Health, Pitié Salpetrière ‐ Charles Foix Hospital (AP‐HP), F‐75013, Paris, France, Paris, France Objective : In most high‐income countries (HICs), births are declining but the proportion of children born to migrant women is rising. Women born in sub‐Saharan Africa (SSA) experience poorer maternal outcomes than native‐born women, potentially linked to modifiable factors such as access to care and differential use of interventions, including caesarean delivery (CD). This study aimed to quantify the disparities in CD rates between migrant women from SSA and native‐born women, overall and by planned or emergency CD and according to the host country characteristics. Study Design : For this systematic literature review and meta‐analysis (PROSPERO: CRD420251043500), we searched PubMed and Embase from January 1, 2000 to February 5, 2026. We included observational studies in HICs comparing CD rates between SSA‐born and native‐born women. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random‐effects models were used. Results : Of 2854 unique references identified, 22 studies were included, of which 72.7% were conducted in European host countries. Overall, this systematic review highlights marked differences in CD rates among women from SSA compared with native‐born women across HICs. In Europe, a consistent regional pattern emerged, with higher CD rates among SSA women than among native‐born women (pooled RR 1.49, 95% CI 1.39–1.61; I 2  = 80.3%). Outside Europe, results were heterogeneous: Australia and Canada showed a similar pattern to Europe, whereas the United States and Israel showed lower CD rates among SSA women than among native‐born women. When examining CD by context, women from SSA were more likely to undergo emergency CD (pooled RR 1.62, 95% CI 1.47–1.78; I 2  = 76.0%), whereas no difference was observed for elective CD (pooled RR 0.87, 95% CI 0.70–1.09; I 2  = 82.4%) compared with native‐born women. Conclusion : In European countries, migrant women from SSA have higher rates of CD, particularly emergency caesarean delivery, compared with native‐born women. These findings should alert clinicians and underscore the need for further research to explain this disparity.

Ronit Silber 1 ; Tal Israeli 1 ; Michal Axelrod 1 ; Sharon Amit 1 ; Michal J. J. Simchen 1 ; Shali Mazaki‐Tovi 1 ; Ariel Rotem 2 ; Michal Fishel Bartal 1 ; Omer Nir 1 1 Sheba Medical Center, Ramat Gan, Israel; 2 Google, New York, NY Objective : To evaluate risk factors, pathogens, and outcomes of individuals with postpartum fever and confirmed bacteremia compared to those without bacteremia. Study Design : We conducted a retrospective study of individuals with postpartum fever at a single tertiary center between 2011 and 2025. Postpartum fever was defined as a temperature > 38 Celsius occurring within 4 weeks of delivery. Blood cultures were routinely obtained for all individuals with postpartum fever. Patients were categorized based on the presence or absence of bacteremia. The primary outcome was a composite adverse maternal outcome (CAMO) including any of the following: length of stay > 7 days, intensive care unit (ICU), readmission, second line antibiotics use, computed tomography (CT) guided drainage, surgical intervention or hysterectomy. Results : Among 150,111 deliveries during the study period, 2717 (1.8%) individuals had postpartum fever, and 1968 (72.4%) met inclusion criteria. Of these, 211 (10.7%) had confirmed bacteremia. The most common pathogens being Enterobacterales, non‐hemolytic Streptococci, and Anaerobes (Figure). Compared to those without bacteremia, affected individuals had higher rates of gestational diabetes, nulliparity (early preterm birth, cesarean delivery, a longer second‐stage labor, greater C‐reactive protein level, and higher temperatures. CAMO was more frequent in the bacteremia group (82.9% vs. 38.38%, aOR 8.56, 95% CI 5.9–12.9). Neonatal outcomes were worse among those with maternal bacteremia, including higher rates of neonatal ICU admission, umbilical artery pH <7.1, and respiratory distress syndrome (Table). Conclusion : Postpartum bacteremia is associated with substantially increased maternal morbidity, prolonged hospitalization, and adverse neonatal outcomes. These findings support the routine collection of blood cultures to guide treatment in febrile postpartum individuals and provide insight into clinical risk factors that may help identify those at highest risk.

Ellie Leidner 1 ; Leo Joskowicz 2 ; Michal Lipschuetz 3 ; Simcha Yagel 1 ; Jacob Sosna 1 ; Amit Haboosheh 1 ; Yishai Sompolinsky 1 1 Hadassah Hebrew University Medical Center, Jeruslaem, Israel; 2 Hebrew University, Jerusalem, Israel; 3 Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel Objective : Unplanned cesarean delivery (UCD) accounts for significant maternal morbidity, largely because cephalopelvic disproportion cannot be reliably predicted before labor onset. We aimed to determine whether automated MRI pelvimetry combined with neonatal head circumference (HC) can predict UCD, and whether UCD and instrumental delivery (IVD) involve distinct pelvic risk profiles. Study Design : Retrospective analysis of 170 women who underwent pelvic MRI for unrelated indications. Sixteen pelvimetric parameters were extracted from T1 and T2 sequences using a validated landmark pipeline, averaged across sequences. Of these, 140 (121 NVD, 19 UCD) and 145 (121 NVD, 24 IVD) were included in respective analyses. Feature selection used SHAP analysis. Logistic regression was evaluated via leave‐one‐out cross‐validation, bootstrap CI and permutation tests ( n  = 1000). Results : Pelvic inlet circumference combined with HC predicted UCD with AUC 0.72 (95% CI 0.60–0.84, p  = 0.001). At optimal threshold, sensitivity was 67%, specificity 72%, and NPV 94%, meaning nearly all women classified as low‐risk delivered vaginally (Figure). UCD was driven by smaller inlet dimensions ( p  = 0.003), while IVD was associated with HC relative to transverse diameter (AUC 0.61), revealing different anatomic profiles. Conclusion : A two‐variable model combining automated pelvimetry with HC can identify women at risk of UCD. Its high NPV supports clinical utility as a reassurance tool. UCD and IVD exhibit distinct anatomic signatures, suggesting different obstruction mechanisms.

Ellie Leidner 1 ; Leo Joskowicz 2 ; Simcha Yagel 1 ; Michal Lipschuetz 3 ; Jacob Sosna 1 ; Amit Haboosheh 1 ; Yishai Sompolinsky 1 1 Hadassah Hebrew University Medical Center, Jeruslaem, Israel; 2 Hebrew University, Jerusalem, Israel; 3 Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel Objective : Cephalopelvic disproportion is a major cause of obstructed labor and unplanned cesarean delivery, yet pelvic dimensions are rarely assessed before labor. We present the first fully automated pipeline that segments the bony pelvis from MRI, localizes obstetric landmarks, and computes pelvimetry without operator input. Study Design : Retrospective pelvic MRI volumes, acquired for clinical indications unrelated to this study, were assembled from nulliparous women delivering at Hadassah Medical Center (2006–2025). The optimal axial sequence was auto‐selected. MRSegmentator produced a 3D bone segmentation validated against radiologist‐corrected ground truth ( n  = 50). The midsagittal plane was estimated via PCA with symmetry refinement. Ten landmarks were extracted and validated against expert annotations ( n  = 56). Ten measurements were computed including obstetric conjugate, AP inlet/outlet, transverse diameter, inlet area, interspinous distance, midpelvis circumference, subpubic angle, and sacral curvature depth. Results : 207 cases were processed (204 with clinical data: 146 vaginal, 27 instrumental, 31 cesarean). Segmentation achieved Dice 0.93 ± 0.04, surface distance 0.45 ± 0.40 mm, HD95 1.64 ± 1.54 mm. Mean landmark error ( n  = 56) was 6.7 ± 2.1 mm. T2 ( n  = 103) and T1 ( n  = 101) were concordant (all p >0.3): obstetric conjugate 136.5 ± 11.5, inlet AP 126.5 ± 11.1, transverse diameter 133.1 ± 7.4, interspinous distance 122.1 ± 9.2 mm, inlet area 84.2 ± 10.0 cm 2 , subpubic angle 109.5 ± 12.0°, sacral curvature depth 22.7 ± 7.5 mm. Women with unplanned cesarean had smaller obstetric conjugate and pelvic inlet than vaginal delivery ( p  < 0.05). Conclusion : This first fully automated, sequence‐agnostic pipeline enables reproducible MRI pelvimetry at scale, supporting personalized delivery planning and CPD risk stratification.

Ingy Farag 1 ; Stephanie Schreiber 1 ; Calla Holmgren 1 ; Annie Dude 2 ; Anna Palatnik 3 ; Rachel K. Harrison 1 1 Advocate Christ Medical Center, Oak Lawn, IL; 2 University of North Carolina at Chapel Hill, Chapel Hill, NC; 3 Medical College of Wisconsin, Milwaukee, WI Objective : To assess the risks of severe maternal morbidity (SMM) and stillbirth by gestational age at delivery among monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies. Study Design : Retrospective cohort study of 7470 MCDA and 32,322 DCDA twin pregnancies delivered within a large national cohort (2017–2021). We excluded higher‐order multiples, conjoined, monochorionic monoamniotic, or unknown twins. Outcomes included SMM, SMM excluding transfusion, and stillbirth, analyzed by gestational age at delivery 34–38 weeks. Analyses used ANOVA, chi‐square, and logistic regression with 38 weeks as the reference. Results : In MCDA pregnancies, deliveries occurred at 34 ( n  = 1,407), 35 ( n  = 1,513), 36 ( n  = 2,506), 37 ( n  = 1,753), and 38 ( n  = 291) weeks. There were no statistically significant differences in SMM or SMM excluding transfusion at ≥34 weeks. But, stillbirth risk rose sharply at 38 weeks (14.4%) compared with 1.1–2.2% at earlier gestations ( p  < 0.001). In DCDA pregnancies, deliveries occurred at 34 ( n  = 3,241), 35 ( n  = 4,458), 36 ( n  = 7,207), 37 ( n  = 9,810), and 38 ( n  = 7,606) weeks. Those delivering at 34 weeks were more likely to be non‐Hispanic black, obese, have hypertension or diabetes, and of lower income ( p  < 0.001). Earlier delivery was associated with higher rates of SMM and SMM excluding transfusion ( p  < 0.001). Stillbirth rates were highest at 34 and 38 weeks (1.4% and 1.8%, respectively, p  < 0.001). In the adjusted analysis, the association between delivery before 38 weeks and adverse maternal outcomes remained, including SMM at 35 weeks (aOR 1.33, 95% CI 1.15–1.54) and SMM excluding transfusion at 34 weeks (aOR 2.00, 95% CI 1.58–2.53). Stillbirth rates were significantly lower at 35 (aOR 0.47, 95% CI 0.33–0.67), 36 (aOR 0.55, 95% CI 0.41–0.73) and 37 weeks (aOR 0.50, 95% CI 0.38–0.65). Conclusion : Delivery timing in MCDA pregnancies did not affect SMM rates but stillbirth risk increased significantly at ≥38 weeks. Earlier delivery in DCDA pregnancies was associated with increased maternal risk likely due to increased rates of hypertensive disorders, while stillbirth risk rose after 37 weeks.

Ingy Farag 1 ; Stephanie Schreiber 1 ; Calla Holmgren 1 ; Anna Palatnik 2 ; Annie Dude 3 ; Rachel K. Harrison 1 1 Advocate Christ Medical Center, Oak Lawn, IL; 2 Medical College of Wisconsin, Milwaukee, WI; 3 University of North Carolina at Chapel Hill, Chapel Hill, NC Objective : To compare delivery timing and hypertensive complications of monochorionic diamniotic (MCDA), dichorionic diamniotic (DCDA), and singleton pregnancies complicated by preeclampsia. Study Design : Retrospective cohort study of pregnancies with preeclampsia using the National Inpatient Sample from 2017–2021. Delivery hospitalizations with ICD‐10 codes for preeclampsia and MCDA or DCDA twins were included. Higher‐order multiples, monoamniotic twins, conjoined twins, and unknown chorionicity were excluded. Outcomes were compared with singleton pregnancies. Primary outcome was delivery at <37, <34, and <28 weeks. Secondary outcomes included severe preeclampsia, HELLP syndrome, abruption, eclampsia, and stillbirth. Analyses included ANOVA, chi2, and logistic regression. Results : Among 435,704 pregnancies with preeclampsia, 2424 (0.6%) were MCDA and 10,897 (2.5%) were DCDA twins. Those with MCDA twins were more likely to be non‐Hispanic white and have gestational diabetes but less likely to have chronic hypertension and history of cesarean section ( p  < 0.001). Both types of twin pregnancies had significantly higher odds of preterm delivery compared with singletons, with greatest risk in MCDA twins. For delivery <37 weeks, adjusted odds ratios (aOR) were 8.58 (95% CI 8.23–8.96) for DCDA and 30.38 (26.85–34.38) for MCDA; for <34 weeks, 3.46 (3.29–3.64) and 6.71 (6.13–7.34); and for <28 weeks, 1.56 (1.36–1.79) and 3.05 (2.44–3.81), respectively. Hypertensive complications were more severe in twins, particularly MCDA gestations. Severe preeclampsia, HELLP syndrome, and stillbirth occurred in 33.9%, 4.5%, and 1.8% of MCDA pregnancies and 21.9%, 4.6%, and 1.6% of DCDA pregnancies, compared with 19.6%, 2.0%, and 0.7% in singletons ( p  < 0.001). There were no differences in rates of eclampsia or abruption. Findings persisted after adjustment. Conclusion : In pregnancies complicated by preeclampsia, MCDA twins have increased odds of early preterm delivery and more severe disease than DCDA twins. Both types of twins have increased risk of adverse outcomes, including stillbirth, compared with singleton pregnancies.

Sophie Callanan 1 ; Gillian A. Corbett 1 ; Aoife Davis 1 ; Siobhan Corcoran 2 ; Fionnuala M. M. McAuliffe 3 1 UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland; 2 National Maternity Hospital, Dublin, Ireland; 3 University College Dublin, Dublin, Ireland Objective : Cardiometabolic health in pregnancy plays an important role in determining pregnancy outcomes. Limited evidence suggests that pregnant women with risk factors for spontaneous preterm birth (sPTB) may metabolically differ to women without risk factors. This study aimed to compare the cardiometabolic profiles in early pregnancy between women at high‐risk and low‐risk of sPTB. Study Design and Methods : This is an analysis of 934 women in early pregnancy from two cohorts: the PrePOP trial (high‐risk women attending the Preterm Birth Clinic at the National Maternity Hosptial (NMH), Dublin) and ROLO (low‐risk women attending the NMH for routine care). In early pregnancy, body mass index (BMI) was calculated and blood samples were obtained to analyse lipid profile, C3 complement, and C‐reactive protein (CRP). Differences in cardiometabolic outcomes were compared between the two groups and adjusted linear regression models were used to control for confounders (age, ethnicity, parity, socioeconomic status, study group, diet quality, wellbeing, early pregnancy BMI, smoking). Results : Of 934 women, 18.7% ( n  = 175) were high‐risk for sPTB. There were more women living with obesity in the high‐risk sPTB group (28.6% vs. 18.9%, p  = 0.042), compared to the low‐risk group. Adjusted analyses found that women at high‐risk for sPTB had higher levels of CRP (mg/L) (B = 5.67; 95% CI 2.81, 8.53; p  < 0.001), total cholesterol (mmol/L) (B = 1.08; 95% CI 0.74, 1.42; p  < 0.001), high density lipoprotein cholesterol (mmol/L) (B = 1.40; 95% CI 1.29, 1.5; p  < 0.001), and lower levels of low density cholesterol (mmol/L) (B = −0.64; 95% CI ‐0.92, ‐0.36; p  < 0.001), compared to women at low‐risk. Conclusion : Women identified at high‐risk for sPTB have distinct cardiometabolic and inflammatory profiles in early pregnancy compared to low‐risk women, which highlights an area for intervention prior to conception to improve pregnancy outcomes.

Shuangying Li 1 ; Nina Dempsey 2 ; Ruixia Liu 1 ; Chenghong Yin 1 ; Alexander E. P. Heazell 3 1 Capital Medical University, Beijing, China (People's Republic); 2 Manchester Metropolitan University, Manchetser, United Kingdom; 3 University of Manchester, Manchester, United Kingdom Objective : Platelet dysfunction among women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) has been widely reported. Dynamics of platelet indices during pregnancy has also been observed. However, evidence on the relationship between platelet indices changes across three trimesters and risk of stillbirth remains limited. The aim of this study was to evaluate the associations between platelet indices, their changes during pregnancy and stillbirth risk. Study Design : This analysis included 136 000 women with livebirths and 542 women with stillbirths having at least one platelet count measured during pregnancy, which was based on a prospective China Birth Cohort Study (CBCS). Routine platelet parameters, including platelet count, plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) and their weekly changes across three trimesters were assessed and correlated with the risk of stillbirth. Data were analyzed using modified Poisson regression models and restricted cubic splines (RCS) analyses. Results : Stillbirth occurred in 4.0‰ of pregnancies for this analysis. In the first trimester, increased stillbirth risk was observed for women with highest quintile of platelet count [adjusted risk ratio (aRR) 1.52, 95% confidence interval (95% CI) 1.13–2.05) and women with lowest quintile of MPV values (aRR 1.59, 95% CI 1.03–2.46) compared with the middle quintile group. From early to late pregnancy, women with excessive increase in platelet count / PCT values per week, and those with excessive decrease in MPV / PDW levels were associated with higher risk of stillbirth. Conclusion : Both increase in platelet numbers and decline in platelet activities during early pregnancy were linked to stillbirth. These fundings also support that serial measurement and monitoring of noninvasive platelet indices throughout pregnancy was essential to improve pregnancy outcomes.

‏Liliya Tamayev; David Sadan; Yossef Mizrachi; Ella Toledano; Daniella Moshe; Eldar Volpert; Liat Gindes Edith Wolfson Medical Center, Holon, Israel Objective : To create a nomogram of corpus spongiosum length (CSL) across gestational ages in male fetuses and assess its value in distinguishing normal development from penile anomalies. Study Design : Prospective cross‐sectional study of 360 low‐risk singleton pregnancies (15–37 weeks). CSL was measured from the proximal edge of the corpus spongiosum to the glans tip and analyzed by gestational age. A gestational‐age–based nomogram was produced and compared with CSL in fetuses with suspected genital abnormalities. Results : The CSL nomogram aligned closely with published data. Of 29 fetuses with suspected penile anomalies, 21 were confirmed. Fetuses with webbed penis (2/5 confirmed) exhibited values within the normal range, supporting a benign variant. Hypospadias cases (16/19 confirmed) demonstrated CSL in the low‐normal range. Micropenis (3/5 confirmed) and ambiguous genitalia (1/2 measurable) had markedly reduced CSL, below two standard deviations for gestational age. Conclusion : The CSL nomogram provides a reliable adjunct for prenatal evaluation of suspected penile anomalies. It enables differentiation between a webbed penis (normal CSL despite external shaft reduction) and ambiguous genitalia/micropenis (abnormally small CSL), while also characterizing hypospadias as presenting with relatively reduced yet mostly normal‐range CSL. Incorporating CSL into routine prenatal ultrasound may guide counseling, and refine clinical decision‐making.

Alva Evertsson 1 ; Ulla‐Britt Wennerholm 2 ; Andreas Herbst 3 ; Karin M. Pettersson 4 ; Maria Jonsson 5 ; Johan Ågren 6 ; Anders Elfvin 7 ; Ulrika Ådén 8 ; Magnus Domellöf 9 ; Sissel Saltvedt 10 ; Henrik Hagberg 2 ; Ylva Carlsson 11 1 University of Gothenburg, Institute of Clinical Sciences, Department of Obstetrics and Gynecology, Gothenburg, Sweden; 2 Department of Obstetrics and Gynecology, University of Gothenburg; Sahlgrenska University Hospital, Gothenburg, Sweden; 3 Department of Clinical Sciences, Lund University, Lund, Sweden; 4 Karolinska Universitetssjukhuset, Stockholm, Sweden; 5 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; 6 Uppsala University Children's Hospital, Uppsala, Sweden; 7 Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; 8 Karolinska Institutet, Stockholm, Sweden; 9 Umeå University / Department of Clinical Sciences / Pediatrics, Umea, Sweden; 10 Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; 11 Sahlgrenska University Hospital, Göteborg, Sweden Objective : To evaluate the clinical use of antenatal magnesium sulfate (MgSO 4 ) for fetal neuroprotection three years after the implementation of national guidelines in Sweden and to identify reasons for its non‐administration. Study Design : In 2020, a national Swedish guideline was implemented, recommending a single 6 g intravenous bolus dose of MgSO 4 for fetal neuroprotection in imminent preterm birth before 32 weeks of gestation. This retrospective cohort study included women delivering between 22 + 0 and 31 + 6 weeks of gestation in 2024 at five Swedish university hospitals. Women who received MgSO 4 for other indications (preeclampsia) and pregnancies with planned neonatal palliative care were excluded. Data were extracted from the medical records. The primary outcome was the proportion of eligible women who received MgSO 4 . Secondary outcomes were timing of administration, repeat dosing, reasons for omission, and coding accuracy. Results : Among 387 eligible women (435 infants), 345 (89.1%) received MgSO 4 , approaching the national target of 90%. Treatment rates did not differ by gestational age, indication for delivery, or mode of delivery. Among women receiving a single dose, the median interval from administration to birth was 3.5 hours (mean 8.1 hours). A single dose was administered in 91.9% of cases (317/345), while 8.1% (28/345) received two doses. Most omissions were due to insufficient time between the decision to deliver and birth (59.5%, 25/42). No cases were attributed to a lack of guideline awareness. Procedure coding was inconsistent, with only 63.8% correctly coded; however, substantial variation between hospitals was observed. Conclusion : The use of MgSO 4 for neuroprotection is well established in Swedish tertiary care, with treatment rates approaching the national target. Remaining gaps largely reflect unavoidable clinical urgency rather than implementation failure. However, suboptimal coding accuracy represents an area for improvement to enable reliable register‐based studies and monitoring of guideline adherence.

Radha Korsoski 1 ; Anna Wessberg 1 ; Marie Blomberg 2 ; Ylva Carlsson 3 1 Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden; 2 Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 3 Sahlgrenska University Hospital, Göteborg, Sweden Objective : To evaluate whether implementation in Sweden of the World Health Organization's WHO Labour Care Guide (LCG), within the PICRINO trial (Can the next generation Partograph based on WHO's latest Intrapartum care recommendations Improve Neonatal Outcomes), affects fear of birth (FOB) among women with antenatal FOB, and to examine associations between staff presence, obstetric characteristics, and FOB. Study Design : This prospective cohort study compared women with FOB receiving standard care (August 2024‐Febuary 2025) with women receiving care based on the LCG (March‐September 2025) at Sahlgrenska University Hospital, Sweden. Women ≥18 years who received FOB counselling completed the Fear of Birth Scale (FOBS) at 27–32 weeks' gestation and two months postpartum. A priori power analysis (α = 0.05, 80% power) indicated that 200 women were required to detect a 20% difference in FOB. The primary outcome was change in median FOBS (ΔFOBS) scores. Non‐parametric tests were used to assess within‐ and between‐cohort differences. Secondary outcomes included associations between postpartum FOBS scores, staff presence, and obstetric factors analyzed using Spearman's correlation and regression models. Results : 277 women were included. Median antenatal FOBS scores were high (81standard care cohort; 79 LCG care cohort). Both cohorts showed postpartum reductions (median ΔFOBS −51 in each), with no difference between cohorts ( p  = 0.71). Staff presence was not associated with ΔFOBS ( p  = 0.37). Obstetric characteristics were similar between cohorts. Higher antenatal FOBS predicted higher postpartum scores. Acute cesarean section, oxytocin augmentation, and postpartum hemorrhage ≥1000 mL were associated with higher postpartum FOB, however only hemorrhage differed between cohorts ( p  < 0.01), with other interventions showing similar patterns across care models. Conclusion : LCG implementation was not associated with differences in FOB among women with pre‐existing FOB. FOB decreased markedly after birth in both cohorts, and obstetric outcomes were comparable.

Efrat Shekel 1 ; Gali Gordon 1 ; nir cohen 2 ; Dina Weinstein‐Mezan 1 ; Michal Lipschuetz 3 ; Doron Kabiri 1 1 Hadassah Hebrew University Medical Center and Hebrew University of Jerusalem, Jeruslaem, Israel; 2 Hadassah Hebrew University Medical Center, Jeruslaem, Israel; 3 Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel Objective : Excessive amniotic fluid, or polyhydramnios, is a common pregnancy complication associated with adverse obstetric and neonatal outcomes. Polyhydramnios is typically diagnosed and monitored via ultrasound using two methods: the Amniotic Fluid Index (AFI) and the Maximal Vertical Pocket (MVP), both are commonly used combined or parallel. This study aimed to evaluate these two diagnostic scales to determine which one more accurately predicts adverse pregnancy and delivery outcomes under the diagnosis of polyhydramnios. Study Design : A population‐based retrospective study was conducted, analyzing a total of 833 patients diagnosed with polyhydramnios according to one or both scales. A multivariable logistic regression analysis was performed to assess the correlation between the diagnosis of polyhydramnios according to each scale and the occurrence of adverse pregnancy and delivery outcomes. Results : The MVP‐based diagnosis of polyhydramnios demonstrated a statistically significant correlation with adverse maternal and neonatal outcomes, specifically in cases of moderate to severe polyhydramnios, with prevalence of 31.4% (aOR‐ 3.19, CI 1.55–6.55, P‐value = 0.002). Conversely, the AFI‐based diagnosis of polyhydramnios did not reveal statistically significant correlation between severity of polyhydramnios and adverse maternal and neonatal outcomes. Conclusion : The MVP method for diagnosing polyhydramnios showed a better predictor of adverse maternal and neonatal outcomes compared to the AFI method. Furthermore, only moderate to severe polyhydramnios was associated with a higher risk for adverse pregnancy outcomes.

Efrat Shekel 1 ; Renana Dimant 1 ; Ido Pinchas‐Akiva 2 ; Lauren Reiman 2 ; Doron Kabiri 1 1 Hadassah Hebrew University Medical Center and Hebrew University of Jerusalem, Jeruslaem, Israel; 2 The Hebrew University of Jerusalem, Israel, Jerusalem, Israel Objective : Intra‐abdominal adhesions are a common complication of repeat cesarean delivery that may increase operative complexity. We aimed to evaluate the association between the number of prior cesarean deliveries and severe intraoperative adhesions, and their impact on operative outcomes. Study Design : We conducted a prospective cohort study of women undergoing elective cesarean delivery at a tertiary medical center between January 2025 and January 2026. Intraoperative adhesions were assessed by a single surgeon and classified into three predefined grades: grade 0, no adhesions; grade 1, mild adhesions not affecting the surgical course; and grade 2, severe adhesions altering the standard surgical approach. The association between prior cesarean deliveries and severe adhesions, as well as operative outcomes including operative time and estimated blood loss, was evaluated using appropriate statistical tests. Results : A total of 233 women undergoing elective cesarean delivery were included. Participants were categorized according to adhesion severity into two groups: 186 women (79.8%) with none to mild intraoperative adhesions (grades 0–1) and 47 women (20.2%) with severe adhesions (grade 2). Women with severe adhesions had a higher mean number of prior cesarean deliveries compared with those with none to mild adhesions ( p  < 0.001). Furthermore, a clear dose–response relationship was observed between the number of prior cesarean deliveries and the rate of severe adhesions (Figure 1). Each additional prior cesarean delivery was associated with nearly twofold higher odds of severe adhesions (OR 1.91 per prior cesarean delivery, p  = 0.0024). Severe adhesions were also associated with a modest increase in operative time (approximately 8% longer; p  = 0.002), whereas estimated blood loss did not differ significantly between the groups. Conclusion : The risk of severe intraoperative adhesions increases progressively with the number of prior cesarean deliveries. Anticipating severe adhesions in women with multiple prior cesarean deliveries may assist preoperative counseling and surgical planning.

Valerie Martin 1 ; Alexander Juusela 1 ; Martin Gimovsky 2 1 Newark Beth Israel Medical Center, Newark, NJ; 2 Newark Beth Israel Medical Center, Newark, RI Objective : To describe maternal and neonatal outcomes in peripartum patients requiring extracorporeal membrane oxygenation (ECMO) and identify physiologic markers associated with survival. Study Design : We conducted a retrospective review of pregnant or ≤6‐week postpartum patients supported with venoarterial (VA) or venovenous (VV) ECMO at a single tertiary center (2017–2026). Data included demographics, ECMO characteristics, anticoagulation, coagulation parameters, and outcomes. The primary outcome was maternal survival to hospital discharge; secondary outcomes included neonatal survival. Unadjusted analyses used Welch's t‐test and Fisher's exact test. Results : Fourteen patients were identified. Median maternal age was 33.5 years (IQR 30.5–35.0) and BMI 37.0 kg/m 2 (IQR 28.3–42.0). ECMO was initiated postpartum in 78.6%, and VA‐ECMO was used in 57.1%. Maternal survival was 71.4% (10/14; 95% CI 41.9–91.6), and neonatal survival was 85.7% (12/14; 95% CI 57.2–98.2). Markers of severe coagulopathy were associated with mortality: INR ≥2.0 (25% vs 90% survival, p  = 0.041) and fibrinogen <150 mg/dL ( p  = 0.045). Non‐survivors had higher BMI (mean difference −9.45 kg/m 2 , p  = 0.036). Survival did not differ by ECMO mode or cardiac arrest at cannulation. All maternal deaths occurred in the postpartum group. Conclusion : Maternal and neonatal outcomes were comparable to contemporary ECMO cohorts. Mortality clustered in patients with laboratory evidence of severe coagulopathy, suggesting that failure of pregnancy hemostatic physiology rather than ECMO modality alone drives adverse outcomes. In pregnancy, where fibrinogen is physiologically elevated, hypofibrinogenemia likely reflects advanced consumptive coagulopathy. These findings highlight the critical role of pregnancy‐specific physiology, including hypercoagulability, inflammatory stress, and hemodynamic shifts, in determining ECMO outcomes. Enhanced monitoring of coagulation parameters may provide early markers of deterioration and guide management in this high‐risk population.

Delvanny Alfikri Rekaputri Wicaksono 1 ; Arya Ivan Mahendra 2 ; Rozi Aditya Aryananda 1 On behalf of Airlangga University 1 Universitas Airlangga; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; 2 Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Objective : To review ultrasound parameters in placenta accreta spectrum with antepartum bleeding patient related with maternal and neonatal outcomes. Study Design : A systematic review was conducted of studies evaluating APB in pregnancies with suspected or confirmed PAS or placenta previa with emphasis on antenatal ultrasound findings and subsequent maternal and neonatal outcomes. A total of 2041 records were identified, and 11 studies comprising 2117 pregnancies were included in the final synthesis. Results : All included studies were observational and predominantly retrospective. Ultrasound features associated with APB or emergency delivery included cervical shortening or abrupt cervical length decline, placental lacunae, loss of the retroplacental clear zone, myometrial thinning, deeper placental invasion, thick placental edge, and abnormal uterovesical hypervascularity. In one cohort, prenatal ultrasound identified PAS with 91.3% sensitivity and 100% specificity. Short cervical length was associated with significantly greater blood loss (1694.7 vs 751.6 mL) and higher hysterectomy rates (15.8% vs 0%). In a large placenta previa cohort, APB was associated with higher emergency cesarean delivery (38.2%), earlier delivery (median 35.1 weeks), preterm birth (85.8%), and NICU admission (50.6%). Conclusion : Ultrasound appears clinically useful for identifying pregnancies at increased risk of APB in PAS, particularly when findings indicate advanced placental invasion, abnormal placental vascularity, or cervical shortening. However, the current evidence remains heterogeneous and largely retrospective. Standardized APB definitions, harmonized ultrasound reporting, and prospective validation studies are needed to develop reliable risk‐stratification models for routine maternal‐fetal medicine practice.

Samantha Kinley; Jocelyn Stairs; Ghislain D'Entremont; Christopher M. Nash Dalhousie University, Halifax, Canada Objective : Current guidelines on twin pregnancies recommend using a first trimester crown‐rump length (CRL) of the larger twin to determine the estimated date of confinement (EDC); smaller studies have questioned this practice. The purpose of this systematic review and meta‐analysis was to assess whether the CRL of the larger or smaller twin more closely estimates the EDC in twin pregnancies conceived by in vitro fertilization (IVF). Study Design : PubMed, Embase, Cochrane Library and ClinicalTrials.gov databases were searched by a trained librarian from inception until January 7, 2025 using keywords related to twin pregnancy, ultrasound, IVF, CRL, growth charts, dating and EDC. Pooled mean differences were calculated using a random effects meta‐analysis and heterogeneity was measured using I 2 statistic. Risk of bias assessments were performed using the Newcastle‐Ottawa scale. This study was registered with PROSPERO. Results : Two authors independently reviewed the studies. Of the 528 articles screened, 8 studies of IVF twin pregnancies that underwent CRL assessment at 7–14 weeks were included; 5 were meta‐analyzed. Included studies were of high quality and low risk of bias. CRL of the smaller twin overestimates EDC by a mean difference of 1.05 days (95% CI: −0.11, 2.22; I 2  = 94.7%); CRL of the larger twin overestimates EDC by 2.44 days (95% CI: 1.35, 3.53; I 2  = 91.4%). Sensitivity analysis stratified by EDC formula contained small sample sizes but similarly demonstrated smaller mean differences when using the CRL of the smaller twin. Conclusion : CRL of the smaller twin resulted in a smaller overestimation of EDC in IVF twin pregnancies compared to CRL of the larger twin, although confidence intervals suggest the estimates were similar. Further studies with consistent EDC formula use and larger sample sizes may further clarify optimal twin dating by first trimester ultrasound.

Ushani Mohapatra 1 ; Marie Blomberg 2 ; Hanna Grundström 1 ; Anna Ramö Isgren 3 ; Louise Lundborg 4 1 Clinical Department of Obstetrics and Gynecology, Region Östergötland, Norrköping, Sweden; 2 Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 3 Linköping University, Linköping, Sweden; 4 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet; Department of Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden Objective : To explore women's experiences of care during childbirth when applying the WHO intrapartum care recommendations and the Labour care Guide (LCG). Study Design : Nineteen semi‐structured online interviews were conducted with women who gave birth in Swedish hospitals during the PICRINO trial ‐ a multicenter stepped‐wedge randomized controlled trial evaluating the WHO intrapartum care recommendations and the Labour Care Guide versus standard care. The interviews were transcribed verbatim and analyzed inductively using reflexive thematic analysis according to Braun and Clarke. Results : The vast majority of women in this study reported a positive childbirth experience which was strongly connected to how they encountered professional care during childbirth. Their experiences were closely linked to three overarching themes: Feeling safe and in capable hands, Being seen and respected as individuals with unique needs and Maintaining a sense of control throughout the birthing process. These themes showed to be highly relevant even for those few women who expressed a mixed och more negative care experience. Conclusion : This study shows that the WHO intrapartum care recommendations and the Labour Care Guide have a high chance of fulfilling women's expectations and needs for a positive childbirth experience and as far as we know this is the first evaluation in a high‐income country.

Jeanette Martinez Renteria 1 ; Venance Basil Kway, Sr. 2 ; Manuel mendoza huerta 3 ; Jorge Flores Sanchez, Sr. 4 ; María Fernanda Cruz García 5 1 Universidad Autónoma de San Luis Potosí, SAN LUIS POTOSI, Mexico; 2 Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosi, Mexico; 3 Hospital Regional de Alta Especialidad “Dr. Ignacio Morones Prieto”, San Luis Potosi, Mexico; 4 Universidad Autónoma de San Luis Potosí, Facultad de Medicina, San Luis Potosi, Mexico; 5 Hospital Regional de Alta Especialidad “Dr. Ignacio Morones Prieto”, San Luis Potosí, Mexico Objective : To evaluate the association between sedentary behavior during pregnancy and metabolic profile alterations, as well as obstetric and perinatal outcomes. Study Design : An observational, cross‐sectional study was conducted in 115 pregnant women ≥37 weeks of gestation. Participants were classified into active, moderately active, and sedentary groups using the Global Physical Activity Questionnaire (GPAQ). Metabolic variables, including glucose, insulin, lipid profile, and HOMA index, were analyzed, along with obstetric and neonatal outcomes. Comparisons between groups were performed using appropriate statistical tests. A multivariate logistic regression model adjusted for gestational BMI, maternal age, and parity was used to assess independent associations. Results : This study demonstrated an inversely proportional relationship between gestational physical activity and the prevalence of metabolic alterations. In the active group, only 16.1% had an abnormal HOMA index, rising to 36.1% in the moderate group and peaking at 43.8% in the sedentary group ( p  = 0.038). Likewise, the prevalence of abnormally high LDL was significantly higher in sedentary patients (70.8%) compared to active ones (48.4%; p  = 0.047). Through a multivariable logistic regression analysis adjusted for maternal age, BMI, and parity, sedentary behavior was established as the primary independent predictor of metabolic risk. Sedentary patients presented a 4.04 times higher risk (OR = 4.04) of developing insulin resistance compared to active patients. Regarding obstetric outcomes, a significant association was observed with the duration of the second stage of labor ( p  = 0.045), with a shorter duration of 1 hour in the active group. Conclusion : Sedentary behavior during pregnancy significantly increases the risk of an adverse metabolic profile (dyslipidemia and insulin resistance) and influences the dynamics of the second stage of labor, independent of other maternal clinical factors. Further studies are needed to determine the influence of perinatal and post‐natal health.

Mackenzie D. Errett; Erica C. Pandolfi; Corinne R. Audette CooperSurgical, Trumbull, CT Objective : In April 2025, an ICD‐10‐PCS code, 0U7C7DJ, was introduced with the intention of greater specificity for temporary mechanical cervical ripening. The objective of this study was to examine national trends of coding and accurate representation of incidence for mechanical cervical ripening, as well as the impact of coding changes. Study Design : This retrospective study utilized aggregated patient and procedure data from the Definitive Healthcare platform. Patients undergoing mechanical cervical ripening between January 2018 and December 2025 were identified using the ICD‐10 PCS codes 0U7C7DZ (Dilation of Cervix with Intraluminal Device, Via Natural or Artificial Opening) and 0U7C7DJ (Dilation of Cervix with Intraluminal Device, Temporary, Via Natural or Artificial Opening). Results : Eight‐year analysis of the code 0U7C7DZ identified 6840 patient cases and 3367 providers (mean 71.25 cases/month). Conversely, only nine months after being introduced, 38,141 patient cases and 12,911 providers were identified using the code 0U7C7DJ (mean 4237.89 cases/month). Code 0U7C7DJ represents 59.47‐fold higher utilization per month. The most common place of service for both codes was the inpatient hospital, followed by outpatient and ambulatory surgical centers. Also, over 92% and 94% of cases were in women aged 18–44 with code 0U7C7DZ and 0U7C7DJ respectively. Conclusion : Despite markedly higher utilization of 0U7C7DJ, both codes vastly underrepresent the incidence of mechanical ripening, given that 31.9% of U.S. births were induced in 2022 and an estimated 84% receive cervical ripening. This likely reveals coding inconsistencies, institutional preference for 0U7C7DJ, and the effects of global obstetric billing. As reimbursement models shift toward unbundled obstetric billing in 2027, accurate coding of cervical ripening will become increasingly important for resource planning and economic analyses. Improved provider education, standardized coding procedures, and payer‐level reinforcement may help coding data more accurately reflect clinical care, ultimately improving data‐driven guideline development.

Mackenzie D. Errett 1 ; Corinne R. Audette 1 ; Sara H. Garmel 2 On behalf of CooperSurgical, Inc. 1 CooperSurgical, Trumbull, CT; 2 Corewell Health, Dearborn, MI Objective : The objective of this study was to assess usability of the cephalic elevation device, Fetal Pillow ™ , and other commonly used methods, such as hand push, for disimpaction. Study Design : A double‐blinded online survey was conducted from March to April 2024. Eligible participants included obstetrician‐gynecologists, maternal‐fetal medicine specialists (MFMs), and certified nurse midwives or certified midwives in the United States, with > 2 years of experience and > 10 deliveries per month. Survey distribution, data collection and analysis, and incentive distribution with reporting, were conducted by a third‐party. Results : Two‐hundred and forty‐six participants completed the survey (response rate 40.2%). Most reported Fetal Pillow as easy to assemble (86%) and easy to use (87%), with 79% able to set it up in < 5 minutes (mean 5.2). Conversely, trained staff assistance for hand push is sought 76.3% of the time before performing hysterotomy (mean 4.8 minutes), while after hysterotomy, trained staff in hand push is sought 23.7% of the time (mean 4.6 minutes). Staff injuries resulting from performing hand push in the prior year were reported by 15% of respondents, 7% for 1–2 injuries, 2% for 3–4 injuries, and 6% for 5 or more injuries. Overall, eight in ten respondents (79%) reported that use of Fetal Pillow is easier than traditional methods, and 71% rated it more effective in elevating the fetal head, rising to 89% among MFMs. Conclusion : This study demonstrates that Fetal Pillow is a user‐friendly tool for fetal head elevation with easy assembly, rapid set‐up, and greater ease of use compared to traditional methods. Set‐up time was comparable to the time it takes locating staff trained in hand push, which may pose staff injury risks. Findings warrant further research on staff safety and potentially decreased risk of staff injury with Fetal Pillow. Results support the assistive device as a valuable alternative for vaginal disimpaction in technically challenging cases of impacted fetal head.

Mackenzie D. Errett 1 ; Corinne R. Audette 1 ; Sara H. Garmel 2 On behalf of CooperSurgical, Inc. 1 CooperSurgical, Trumbull, CT; 2 Corewell Health, Dearborn, MI Objective : The objective of this study was to examine provider experience of access and usability for the Bakri ® Postpartum Hemorrhage Balloon. Study Design : A double‐blinded online survey was conducted in 2024 among obstetrician‐gynecologists (OB‐GYNs), maternal‐fetal medicine specialists, and certified nurse midwives or certified midwives with > 2‐years‐experience in the United States, in their role and > 10 deliveries monthly. Providers with <75 births per month at their facility, no NICU or level 1 NICU were excluded. Survey distribution, data collection and analysis, and incentive distribution with reporting were conducted by a third‐party. Results : Two‐hundred and thirty‐seven participants completed the survey, yielding a 40.2% response rate. Seventy‐three percent reported the Bakri Postpartum Hemorrhage Balloon is easy to set up. The majority of participants reported the device was a good value for their facility (76%), easy to use (76%), and allowed them to stop bleeding even in the presence of blood clots (75%). Almost nine in ten respondents (87%) reported confidence in the staff's ability to prepare, set up, and use the device. Eighty‐eight percent of OB‐GYNs reported either good or almost unlimited access to Bakri. Over half of respondents (52%), who have used the device report that it can control bleeding in 10 minutes or less. Conclusion : Findings from this study emphasize a high level of satisfaction and usability associated with the Bakri Postpartum Hemorrhage Balloon. Confidence in staff competency in setting up and use of the device was notably elevated. Good or almost unlimited accessibility of the device suggests it is widely available in facilities surveyed. Clot formation during management of postpartum hemorrhage does not appear to be a limiting factor for efficacy. The demonstrated ease‐of‐use and high accessibility positions the Bakri Postpartum Hemorrhage Balloon as a practical solution in managing primary postpartum hemorrhage.

Eline B. Seljeflot 1 ; Torbjørn M. Eggebø 2 ; Birgitte H. Kahrs 2 ; Kjersti Westvik‐Johari 3 ; Signe Opdahl 3 1 NTNU/ St. Olavs hospital, Trondheim, Norway; 2 NTNU, Trondheim, Norway; 3 Norwegian Univeristy of Science and Technology, Norwegian Univeristy of Science and Technology, Norway Objective : To examine temporal trends in preterm birth (< 37 + 0 weeks) following ART (assisted reproductive technology) and NC (natural conception) in Norway from 1988 to 2022, and to assess the contributions of spontaneous and provider‐initiated preterm births. Study Design : Cohort study of all births in the Medical Birth Registry of Norway, excluding births at maternal age <18 or ≥46 years, gestational age <22 or ≥45 weeks, birthweight  + 6 SD. Results : The study included 1,901,933 NC and 41,919 ART‐conceived pregnancies. Mean maternal age was 33.3 years after ART and 29.3 years after NC, and nulliparity was more common in ART (62% vs 41%). Throughout the study period, the risk of preterm birth was higher after ART (13.2%) than after NC (5.75%) (Figure 1). For ART‐conceived pregnancies, the risk was three times higher in the earliest (1988–92) than in the latest (2018–22) study years (OR 2.93, 95% CI 2.48–3.47), largely explained by the declining proportion of multiple births. Among singletons, the risk of preterm birth was also higher after ART (8.3%) than after NC (5.2%). Compared with 2018–22, ART‐conceived singleton pregnancies had a markedly higher risk of preterm birth in 1988–92 (OR 1.78, 95% CI 1.40–2.28) (Figure 2). In NC pregnancies, the risk remained relatively constant but was slightly higher in 1988–1992 than in 2018–2022 (OR 1.18, 95% CI 1.15–1.21). Among all preterm NC births, the proportion of provider‐initiated preterm birth increased from 29.6% in 1988–92 to 42.3% in 2018–22, with a similar increase among singletons (29.5% to 40.5%) (Figures 1–2). In ART‐conceived pregnancies, the increase was weaker, rising from 45.2% to 49.4% (46.3% to 47.3% for singletons). Conclusion : The risk of preterm birth is higher following ART than after natural conception, also when multiple pregnancies are excluded. Over time, the proportion of provider‐initiated preterm births increased in naturally conceived pregnancies, approaching the levels observed in ART‐conceived pregnancies.

Eline B. Seljeflot 1 ; Birgitte H. Kahrs 2 ; Torbjørn M. Eggebø 2 1 NTNU/ St. Olavs hospital, Trondheim, Norway; 2 NTNU, Trondheim, Norway Objective : To examine whether there are sex dependent growth differences as early as the first trimester, specifically at the timepoint when ultrasound‐based gestational age estimation is performed. Study Design : Prospective observational study conducted at St. Olavs hospital, Trondheim University Hospital. Between 2022 and 2024, we recruited 111 women who achieved pregnancy following assisted reproductive technology (ART) and embryo transfer of a day 5 blastocyst. Ultrasound examinations were performed 70 days after embryo transfer, corresponding to gestational week 12 + 5. The neonate's biological sex was obtained from birth records. Results : The mean maternal age by inclusion were 33.6 years (SD 4.1), and the mean BMI 25.2 (SD 4.0). Among the 111 foetuses, 59 (53%) were boys and 52 (47%) were girls. Male foetuses had longer crown‐rump length (CRL) ( p  = 0.04) and biparietal diameter (BPD) ( p  = 0.0008) compared with female foetuses (Table 1). We also observed a tendency toward a sex‐related difference in femur length (FL); however, this difference did not reach statistical significance. Conclusion : Sex‐dependent growth differences could be detected as early as the first trimester in pregnancies conceived by ART.

Mary Vadnais 1 ; Alexander Keenan 2 ; Jacquline Pesa 3 ; Louis Jackson 3 ; Caroline Brethenoux 4 ; Ashley Orillion 3 1 Atlantic Health System, Morristown, NJ; 2 Johnson & Johnson, Titusville, NJ; 3 Johnson & Johnson, Horsham, PA; 4 Human Dot + , Paris, France Objective : To characterize patient and caregiver sentiments related to HDFN using digital conversations and assess variation across the diagnostic and therapeutic journey. Study Design : Public‐domain, English‐language digital conversations posted between October 2021 and October 2023 were extracted from a range of channels, including message boards, topical sites, comments and social networks with U.S.‐based IP addresses. Conversations from individuals self‐identifying as maternal patients with HDFN or caregivers were included. Advanced natural‐language processing was used to annotate content and categorize mindsets and sentiments across stages of care. Results : A total of 17,283 patient and caregiver conversations related to HDFN were identified. Conversations focused on testing (23%), diagnosis (39%), therapy (32%), and post‐therapy monitoring (6%). Across all stages, sentiment was neutral (48%) or negative (40%), reflecting limited information related to testing, diagnosis and therapy. Mindset analysis revealed high levels of uncertainty (33%) and anxiety (32%). In contrast, post‐therapy monitoring showed a marked shift, with 85% of conversations expressing positive emotions and gratitude. Conclusion : Social listening reveals substantial unmet informational and emotional needs among those affected by HDFN, particularly during the early phases, underscoring the need for education and anticipatory guidance. Improved sentiment following treatment highlights both the complexity of navigating a rare, serious condition and the importance of timely intervention. These findings demonstrate the value of patient and caregiver insights in informing education and support strategies for rare diseases.

Yonatan Dror 1 ; Tal Israeli 1 ; Ariel Rotem 2 ; Omer Nir 1 ; Michal Axelrod 1 ; Yuval Dellaricha Vaisman 1 ; Maor Givon 1 ; Michal J. J. Simchen 1 ; Roy Mashiach 1 ; Shali Mazaki‐Tovi 1 ; Michal Fishel Bartal 1 1 Sheba Medical Center, Ramat Gan, Israel; 2 Google, New York, NY Objective : Septic Pelvic Thrombophlebitis (SPT) is a rare and often underdiagnosed postpartum complication. This study aimed to characterize the clinical presentation, laboratory and imaging features of patients diagnosed with postpartum SPT. Study Design : We conducted a retrospective cohort study at a single tertiary medical center between March 2011 and May 2025. We reviewed all postpartum patients who underwent abdominal‐pelvic CT scans due to infectious indications and included those with SPT confirmed by computed tomography (CT). Patients’ charts were reviewed for baseline characteristics, pregnancy history, labor course and postpartum clinical course. Results : Among 150,331 deliveries during the study period, 55 individuals were diagnosed with SPT (0.04%). Cesarean delivery was more common than vaginal delivery among affected individuals (61.8% vs. 38.2%). Presenting symptoms included abdominal pain (49.0%), fever (40%), and fever refractory to antibiotic treatment (16.3%). Bilateral SPT was observeded in 20%, and 30.9% had associated pelvic abscesses. The median time from delivery to CT scan was 9.4 days. Median CRP at initial CT was 90.8 mg/L, peaking at 126.6 mg/L; median WBC rose to 14.7×10 9 /L. Bacteremia was present in 7.3%, while 47.3% had postpartum fever. ICU admission occurred in 5.5%, and two patients (3.6%) required postpartum hysterectomy. Conclusion : Postpartum SPT is a rare but potentially serious diagnosis that presents with nonspecific symptoms. High clinical suspicion and early use of CT imaging are key to diagnosis. Elevated inflammatory markers may aid in early recognition, especially in patients with persistent refractory fever and abdominal pain. Recognizing these patterns may help guide imaging decisions and prompt appropriate therapy, potentially reducing morbidity.

Mymy Nguyen 1 ; Jordan A. Beacham 1 ; Lydia Hu 2 ; Vincenzo Berghella 3 1 Thomas Jefferson University Hospital, Philadelphia, PA; 2 Atlantic Health System, Morristown, NJ; 3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA Objective : Vesicovaginal fistulas (VVF) and vesicocervical fistulas (VCF) are rare but serious complications of cerclage, potentially occurring in up to 1.3% of cerclages. This systematic review aimed to evaluate patient characteristics, clinical presentation, management, and pregnancy outcomes in published cases of VVFs and VCFs. Study Design : The study protocol was registered with Prospero (CRD420251038391). Case reports, case series, reviews, cohort trials, and RCTs reporting VVF/VCF diagnosed after cervical cerclage placement were eligible. To be included, studies had to report individual patient data, including the gestational age at delivery, and be in English. Two reviewers independently screened records and extracted data. Extracted information included patient demographics, cerclage characteristics, fistula details, and pregnancy outcomes. Results : From 363 evaluated articles, 9 studies met inclusion criteria, totaling 10 cases of VVF or VCF with 1 new case presented in this article. Regarding cerclages, 90% were history‐indicated and 80% used a McDonald cerclage. 70% had a cerclage in a prior pregnancy. Fistulas were classified as VVF in 70% of cases and VCF in 30%. Urinary incontinence (90%) was the most common clinical presentation. The fistulas were identified within one month post‐procedure in 50% of cases. Repair occurred antepartum in only 20% of cases with 60% performed transvaginally. 60% of pregnancies reached term, with a mean gestational age at delivery of 35 weeks and 90% perinatal survival rate. Conclusion : This systematic review identifies some typical characteristics of cerclage‐related fistulas. There should be a high index of suspicion for VVF/VCF if patients report urinary incontinence after cerclage. Although antepartum repair with cerclage replacement is an option, good perinatal outcomes (90% perinatal survival) were achieved even when the fistula was managed postpartum. Acknowledging this VVF/VCF risk is vital as cerclage indications expand and evidence shows that higher cerclage placement on the cervix in close proximity to the bladder is associated with lower preterm birth risk.

Sneha Paranandi 1 ; Adam Wright, Jr. 1 ; Mackenzie Cronin 1 ; Anthony C. Sciscione 1 ; Fabrizio Zullo 2 ; Daniele Di Mascio 2 ; Suneet P. Chauhan 1 1 ChristianaCare, Newark, DE; 2 Sapienza University of Rome, Rome, Italy Objective : Among newborns with hypoxic ischemic encephalopathy (HIE) that had whole‐body cooling (WBC), our co‐primary objectives were: inter‐observer variation in fetal heart rate tracing (FHRT) and if there were “protective features” (e.g. moderate variability) just prior to birth. Study Design : This planned secondary analysis of our prior publication included all non‐anomalous singleton newborns treated with WBC at a community teaching hospital. PGY‐I, PGY‐IV and MFM faculty reviewed FHRT using 20 min epochs at 120 min prior to delivery and the final 20 min before tracing cessation and delivery. FHRT interpretation followed ACOG Clinical Practice Guideline #10 (PMID: 40966736 ) and the International Consensus on cardiotocography interpretation (PMID: 39378709 ), including assessment for the ZigZag (ZZ) pattern. Cochran‐Armitage Chi‐Square test for trend and Pearson's chi‐square test were used for analysis; p  < 0.05 was significant. Results : Of the 132 newborns treated with WBC over 63 months, FHRT was available in 130 (98%). For the 120–100 min before birth epoch, interpretations were similar among the clinician groups for: i) whether FHRT was uninterpretable for category I, II or III; ii) tachycardia; iii) absent variability; iv) prolonged decelerations; and v) presence of the ZZ pattern. Interpretations of all other FHRT descriptors differed significantly (Table 1). In the last 20 min of FHRT, interpretations were similar for: i) presence of high‐risk features; ii) absent variability; and iii) presence of the ZZ pattern. All other aspects of FHRT interpretation differed significantly. Depending upon the interpreter, about 40 to 80% had protective features before the cessation of FHRT (Table 2). Conclusion : There is significant inter‐observer variability for most descriptors of fetal heart rate tracing – including if Category I, II or III – among those with hypoxic ischemic encephalopathy who underwent whole‐body cooling. Before discontinuation of tracing, moderate variability is observed frequently. The ZigZag pattern, identified in <5% of cases, has questionable utility in this cohort.

Noa Leybovitz Haleluya 1 ; Gil Gutvirtz 2 ; Anastasia Bendet 3 ; Tamar Wainstock 4 ; Eyal Sheiner 2 1 Soroka Medical Center, Meitar, Israel; 2 Soroka University Medical Center, Beer Sheva, Israel; 3 Soroka Medical Center, Beer Sheba, Israel; 4 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel Objective : Endometriosis is a chronic gynecological condition that affects women in their reproductive age and could potentially lead to reproductive difficulties. Despite extensive research into the impact of endometriosis on fertility and reproductive health, its’ association with obstetric complications and short‐term neonatal outcomes is still an area of limited understanding with conflicting evidence in published studies. We conducted this study to explore a potential effect of endometriosis on obstetric and neonatal outcomes. Study Design : A retrospective population‐based cohort study was conducted comparing obstetric and perinatal complications in women with and without endometriosis. We evaluated all singleton deliveries that occurred between 1991 and 2021 at a tertiary medical center. Fetuses with chromosomal abnormalities or congenital malformations were excluded. Generalized estimation equation (GEE) models were used to control for maternal recurrence in the cohort and for confounding variables. Results : During the study period, 232,476 deliveries met our inclusion criteria, 0.1% ( n  = 224) of whom had documented endometriosis. Women with endometriosis were significantly older, had higher rates of infertility and diabetes mellitus, and were more prone to undergo a cesarean delivery. Also, these women had higher rates of preterm delivery and low birthweight infants. Yet, overall perinatal mortality was comparable between the groups. In the GEE models, after controlling for maternal age and fertility treatments, the association for most of the aforementioned variables was no longer statistically significant. However, women with endometriosis were found to have a significant independent higher risk for cesarean delivery (adjusted OR 2.19, 95% CI 1.66–2.90, p  < 0.001). Conclusion : Among the obstetrical and perinatal complications investigated in this study, endometriosis was found to be an independent risk factor for cesarean delivery, while all other pregnancy outcomes were comparable to women without endometriosis.

Nichola Bomani Gonzalez 1 ; Vincent Tang 1 ; Casey Lower 1 ; Harshini Chaganti 2 ; Malini Persad 1 ; Joanne N. Quiñones‐Rivera 3 ; Danielle Durie 1 ; Merritt Ebner 1 ; Hope Kincaid 1 ; Meredith Rochon 1 1 Lehigh Valley Health Network, Jefferson Health, Allentown, PA; 2 Thomas Jefferson University School of Medicine, Philadelphia, PA; 3 Lehigh Valley Health Network, Allentown, PA Objective : Pregnancies complicated by fetal growth restriction (FGR) often undergo induction (IOL). The safety of using misoprostol (PGE1) versus mechanical methods for IOL in this population remains uncertain due to the risk of tachysystole and irreversible nature of PGE1. We evaluated the impact of use of PGE1 for individuals undergoing IOL for FGR. Study Design : Retrospective cohort study of all singleton pregnancies undergoing IOL for FGR at a community‐academic center from 2019–2024. Individuals with prior cesarean delivery (CD), any contraindication to vaginal delivery, or significant fetal anomalies were excluded. Induction management was at the discretion of the obstetrical team. Those receiving PGE1 were compared to those who did not. The primary outcome was CD rate. Secondary outcomes included select maternal and neonatal outcomes. Results : 298 individuals with FGR undergoing IOL were included, 59 (19.7%) of which received PGE1. Individuals in the PGE1 group were less likely to be multiparous, had a later gestational age (GA) and lower Bishop score at time of IOL, and were more likely to need cervical ripening (Table 2). GA at time of FGR diagnosis, estimated fetal weight (EFW), EFW percentile, rates of severe FGR (< 3rd percentile), abnormal Doppler waveforms and rates of hypertensive disorders at time of IOL were similar between groups. The majority of the PGE1 group had one PGE1 dose (71%) and had PGE1 along with a cervical Foley (83%). There was no difference in CD rate (13.6% PGE1 group vs 13.0% no‐PGE1 group, p  = 0.904), neonatal intensive care admission, or maternal adverse outcomes. After adjustment for parity, Bishop score and need for cervical ripening, CD rate remained similar between groups and was associated with parity (aOR 4.91, 95% CI 1.29–18.7, p  = 0.02), not exposure to PGE1 (aOR 0.27, 95% CI 0.05–1.30, p  = 0.102). Conclusion : In individuals undergoing IOL for FGR, use of PGE1 was not associated with an increased risk of CD or adverse maternal/neonatal outcomes compared to those undergoing IOL without PGE1. These findings support the use of PGE1 for IOL in this high risk population.

Sarriyah A. Hanif 1 ; Leya Khan 2 ; Kartikeya Menon 3 ; Nicola F. Tavella 4 ; David Yacynych 5 ; Victoria Ly 3 ; Leslie J. Warren 3 ; Rafi Rozan 6 ; Chelsea A. Debolt 1 ; Peter S. Bernstein 3 ; Wan‐ju Wu 3 ; Noel Strong 3 1 Mount Sinai Hospital, New York, NY; 2 Stony Brook University, Stony Brook, NY; 3 Icahn School of Medicine at Mount Sinai, New York, NY; 4 Maternal‐Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; 5 Carl R. Darnall Army Medical Center, Fort Cavazos, TX; 6 Georgetown Public Hospital Corporation, Georgetown, Guyana Objective : Guyana has higher maternal and neonatal morbidity rates compared to other Latin American and Caribbean countries, with a wide disparity between socioeconomic classes. In 2012, fetal heart rate tracing (FHT) was implemented in Guyana and it was associated with an increase in cesarean sections for non‐reassuring status. Our team initiated a longitudinal intrapartum FHT education program to evaluate existing practitioner knowledge and assess if formal training improved FHT interpretation over time. Study Design : This was a prospective observational study conducted among 49 midwives at a single academic institution in Guyana. Two maternal fetal medicine physicians from an academic institution in New York City facilitated 5‐hour training sessions in November 2024 and February 2025. Immediately before and after the first session, participants completed identical pre‐ and post‐tests consisting of 19 questions assessing knowledge and management of FHT. Eight participants with lower performances in the first session were given an additional pre‐test prior to the second training session. A two‐tailed paired T‐test analyzed test performance across the three exams. Results : Of the 49 participants, 41 (84%) improved their post‐test scores following the first training session ( p  < 0.001, 95% CI). Eight participants completed an additional assessment prior to the second session and five (63%) achieved higher scores on their second pre‐test than their initial pre‐test ( p  = 0.020, 95% CI); but all participants scored lower on their second pre‐test compared to their first post‐test ( p  = 0.001, 95% CI). Topics that they struggled with across all tests included basic definitions, resuscitative measures, and interpretation of sample FHT. All participants expressed interest in additional courses, specifically in management of category 2 tracings. Conclusion : This study revealed the potential of single FHT training sessions to significantly improve accuracy of FHT interpretation among obstetric providers in resource‐limited settings. There is a need for sustained engagement to ensure skill retention among providers.

Francesca Maria Paola M. P. Gigli 1 ; Valentina Romagnoli 2 ; Ilaria Pozzi 2 ; Marina Tartarone 2 ; Martina Zoppetti 2 ; Gaia Cremascoli 2 ; Elisa Possente 2 ; Caterina Gasparini 2 ; Benedetta Grassini 2 ; Francesca Parisi 3 ; Enrico Iurlaro 3 ; Emanuela Taricco 3 ; Elena Cesari 3 ; Tatjana Radaelli 3 ; Irene Cetin 3 1 Università degli Studi Di Milano, Milano, Italy; 2 Università degli Studi di Milano, Milano, Italy; 3 S. C. Ostetricia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy Objective : Induction of labor frequently requires cervical ripening in women with an unfavorable cervix. Mechanical methods such as cervical ripening balloons are widely used; however, the optimal duration of placement remains uncertain. This study aimed to compare the effectiveness and safety of a 6‐hour versus a 12‐hour balloon placement protocol, with particular focus on time to delivery and induction outcomes. Study Design : We conducted a retrospective, monocentric cohort study including 1588 women undergoing induction of labor with a cervical ripening balloon at a Tertiary Obstetric Unit in Milan. Patients were stratified into two groups according to balloon placement duration (6 hours, n  = 708; 12 hours, n  = 880). The two protocols were used in two different periods between January 2024 and October 2025. Maternal, obstetric, and neonatal outcomes were compared. Multivariable regression analyses were performed to assess the association between balloon placement duration and outcomes, adjusting for potential confounders. Results : Maternal characteristics were comparable between groups. The 6‐hour protocol was associated with a significantly shorter time to delivery (−81 minutes, p  < 0.001). Rates of vaginal delivery were similar between groups (69.8% vs 64.5%), while cesarean delivery rates showed a non‐significant reduction in the 6‐hour group (18.6% vs 22.4%). Importantly, the risk of cesarean section due to induction failure or cervical dystocia was significantly lower with the 6‐hour protocol (5.2% vs 10.5%, p  < 0.001), and this finding remained significant after adjustment (aOR 0.40, 95% CI 0.24–0.67). No significant differences were observed in other maternal or neonatal outcomes. Conclusion : A 6‐hour balloon placement protocol is associated with reduced time to delivery and a lower risk of induction failure, without compromising maternal or neonatal safety. A shorter balloon placement duration may represent an effective and more efficient strategy for cervical ripening in routine clinical practice.

Adam Crosland 1 ; Lucy Ward 1 ; Robert Edenfield 2 ; Daniel Kruger 3 ; Jacob Aday 4 ; Stephanie Lake 5 ; Philippe Lucas 4 ; Jamie O. Lo 1 On behalf of Real World Psychedelics Consortium 1 Oregon Health & Science University, Portland, OR; 2 Oregon National Primate Research Center, Beaverton, OR; 3 University at Buffalo, State University of New York, Buffalo, NY; 4 University of Michigan, Ann Arbor, MI; 5 University of California, Las Angeles, Los Angeles, CA Objective : Psychedelic use is rising among reproductive aged individuals despite limited reproductive safety data. This study aims to examine if female respondents are willing to discuss psychedelic use and its potential impact on reproductive healthcare with providers, and how this varies with varying legalization of psychedelics. Identifying barriers to patient‐provider communication is critical to inform clinical counseling, research prioritization, and public health messaging. Study Design : The 2025 Global Psychedelic Survey (GPS) is an international cross‐sectional survey of psychedelic use patterns and perspectives that included a 20‐item module assessing perceptions of psychedelics’ effects on reproductive domains. This secondary analysis includes self‐identified females who answered at least one of the reproductive health questions. We compared willingness to discuss psychedelics’ impact on reproductive health domains (menstruation, contraception, fertility, and pregnancy) with a healthcare provider, stratified by reported psychedelic legalization in participants’ area of residence (decriminalization/deprioritization: Yes, No, Don't Know). Chi‐square tests were performed to analyze the relationship between decriminalization and reported willingness. Results : Among 3016 respondents, 792 (26.3%) reported living in an area where psychedelics are decriminalized, 1779 (59.0%) did not, and 446 (14.8%) did not know. Across reproductive domains, individuals living in a decriminalized area reported greater willingness to discuss psychedelic impacts with providers than those living in a non‐decriminalized area. These differences were statistically significant for the domains of menstruation, contraception, and fertility (p‐values = 0.008, 0.004, 0.008 respectively). Conclusion : Legal context may influence respondents’ comfort with patient‐provider communication around psychedelic use and reproductive health. These findings highlight the need for proactive, nonjudgmental counseling strategies and underscore the importance of addressing policy‐related barriers to patient–provider communication.

Enrico Corno; Michela Taverna; Elena Ferraboschi; Sara Colarossi; Matteo Charles Malvezzi; Andrea Dall'Asta University of Parma, Parma, Italy Objective : To investigate the risk factors for failed instrumental delivery preceded versus non‐preceded by ultrasound to assess the fetal head position. Study Design : Secondary analysis of PROPENSITY‐ID, an international, multicenter, prospective data collection or retrospective analysis of prospectively collected routine clinical data involving tertiary maternity units with reported instrumental delivery rates around 5% or above. The study population was divided into women who underwent intrapartum ultrasound for the evaluation of the occiput position prior to instrumental delivery and those having clinical assessment only, and risk factors for failed instrumental delivery were compared between the two cohorts. Results : 3551 cases from 24 participating centers were included, of whom 1195 (33.6%) had instrumental delivery preceded by the use of ultrasound. In cases preceded by intrapartum ultrasound failed instrumental delivery was recorded in 20 (1.8%) and independently associated with higher BMI (30.6 + 7.2 vs 27.0 + 4.4; p  < 0.01) and fetal head station (+ 1(0 − + 3) vs + 2(0 − + 5); p  = 0.03). In cases having clinical assessment of the occiput position failed instrumental delivery was recorded in 35 (1.5%) and independently associated with nulliparity (65.7 vs 31.7%, p  < 0.01), use of instrument different from vacuum extractor (82.8% vs 57.1%, p  < 0.01) and occiput posterior position (83.5% vs 60.0%, p  < 0.01). Conclusion : Risk factors associated with failed instrumental delivery seem to differ in cases preceded versus those non‐preceded by intrapartum ultrasound assessment of the occiput position. Ultrasound evaluation prior instrumental delivery may impact on the risk factors for failed instrumental delivery.

Chiara Melito 1 ; Enrico Corno 1 ; Maria Elena Flacco 2 ; Maciej Krasinski 3 ; Giovanni Cioni 2 ; Giovanna Letizia Calò 2 ; Christoph Lees 4 ; Beatrice Mercuriali 1 ; Sara Colarossi 1 ; Giulina Suma 1 ; Andrea Dall'Asta 1 1 University of Parma, Parma, Italy; 2 University of Ferrara, Ferrara, Italy; 3 Imperial College Healthcare NHS Trust London, London, United Kingdom; 4 Imperial College Health Care NHS Trust London, London, United Kingdom Objective : To evaluate and compare morbidity rates in non‐anomalous appropriately sized (AGA) versus growth restricted (FGR) fetuses delivered prior 37 weeks of gestation. Study Design : MedLine and Scopus databases were searched to identify studies evaluating the incidence of: respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), hypoglycemia, post‐natal death and hyperbilirubinemia, among AGA and FGR born preterm. Inclusion criteria were: cohort design(prospective or retrospective); pregnancies complicated by prematurity(gestational age <37 weeks), in presence or not of FGR defined as a EFW <10percentile; European or Scandinavian setting; outcomes of interest evaluated at different weeks of gestation. When enough data were available, all analyses were re‐run including only the studies providing specific data for newborns <32 weeks. Between‐study heterogeneity was quantified using the I statistic. Results : Database searching identified a total of 11367 records. 43 full‐text articles were assessed for eligibility and 12 studies were included in the final analysis. Preterm FGR was associated with higher risk of postnatal death (OR 3.16; [2.26–4.41]), BPD (OR 3.24; [1.30–8.08]) and hypoglycemia (OR 3.80[1.40–10.31]) compared to AGA, but not of IVH and hyperbilirubinemia. Sub‐ analysis performed for neonates born prior to 32 weeks showed a higher risk of postnatal death (OR 3.04; [2.25–4.11]) and BPD (OR 3.53; [1.36–9.13]) in FGR. Conclusion : Preterm FGR is associated with an over three‐fold higher risk of of postnatal death, BPD and hypoglicemia, but not of IVH and hyperbilirubinemia, compared to preterm AGA.

Johanna Sjöberg 1 ; Anna Ramö Isgren 1 ; Marie Blomberg 2 1 Linköping University, Linköping, Sweden; 2 Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden Objective : Childbirth experience is an important quality indicator of obstetric care. WHO's Labour Care Guide (LCG), promotes woman‐centered intrapartum care and is expected to improve childbirth experiences. Although, evidence remains limited, especially in high‐resource settings. This study compared childbirth experiences among women receiving standard care with LCG‐based care within the trial Can the use of a next generation Partograph based on WHO's latest Intrapartum Care Recommendation Improve Neonatal Outcomes (PICRINO), conducted in Sweden during 2023–2025. Study Design : Five labor wards participating in the PICRINO trial invited women to participate; exclusions were twin pregnancy, preterm or breech delivery, inability to read Swedish, and age ˂18 years. Childbirth experience was measured 3–5 weeks postpartum using the Childbirth Experience Questionnaire 2 (CEQ2). Total and CEQ2 domain scores (range 1.0–4.0, higher scores indicate more positive experiences) were compared between the groups. Results : A total of 517 questionnaires were collected (standard n  = 207; LCG n  = 310), response rate 85.6%. Small effect sizes in mean values were observed between the groups of standard vs LCG care for total CEQ2; 3.45 vs 3.36, and domains own capacity ; 2.94 vs 2.87, professional support ; 3.70 vs 3.66, perceived safety ; 3.48 vs 3.32 and participation ; 3.70 vs 3.58. Multiple linier regression analysis, adjusting for parity, fear of childbirth and onset of labor showed no differences in means between standard vs LCG care in total CEQ2 (B = −0.08, p  = 0.06) or the domains own capacity (B = −0.02, p  = 0.66) and professional support (B = −0.05, p  = 0.28), but for the domains perceived safety (B = −0.13, p  = 0.02), and participation (B = −0.11, p  = 0.04). Conclusion : Childbirth experience scores were high in both groups, with no clinically relevant differences between standard care and LCG‐based care. These findings suggest that both models function well in high‐resource settings, with regard to childbirth experience.

Maria Jimena Barroso Alverde 1 ; Andrea Mizrahi Drijanski 1 ; Ximena Sepúlveda Enriquez 2 ; Andrea Portillo 2 ; Laura S. Morales Contreras 1 ; Salomon Daniel Roberto Pardo Roca 3 ; Diego A. Roeder Ramirez 1 ; Sion Yu Jang 1 1 Universidad Anáhuac México, Huixquilucan, Mexico; 2 Universidad Anáhuac México, Mexico City, Mexico; 3 Universidad Anáhuac Querétaro, Queretaro, Mexico Objective : To map how obstetric violence is defined, measured, and addressed in Mexico and identify gaps between policy frameworks and their implementation in clinical practice. Study Design : A scoping review was conducted following PRISMA‐ScR guidelines. PubMed and Scopus were searched for studies published between 2010 and March 2026 in English or Spanish. Grey literature and policy documents were identified through targeted searches. Records were independently screened by three reviewers, and data were extracted using a standardized form. Evidence was synthesized using descriptive statistics, thematic analysis, and a policy–practice comparison framework. Results : A total of 108 records were identified (PubMed n  = 62; Scopus n  = 46). After removal of 30 duplicates, 78 records were screened and 32 full‐text reports assessed. One report was excluded, leaving 31 studies in the final analysis. Publications increased over time and were mainly qualitative or observational. Definitions and measurement approaches varied substantially, with few validated instruments. Common findings included mistreatment, lack of informed consent, discrimination, and structural drivers such as institutional hierarchies and resource constraints. Despite legal recognition, evaluated interventions were limited and policy–practice gaps were consistently observed. Conclusion : Despite legal recognition of obstetric violence in Mexico, a persistent gap remains between policy and clinical practice. This gap is driven by inconsistent measurement, limited evaluation of interventions, and weak implementation and accountability mechanisms. Standardized measurement tools, strengthened provider training, and improved monitoring and enforcement are needed to ensure respectful maternity care.

Jakub Mlodawski 1 ; Anna Zmelonek‐Znamirowska 1 ; Marta Mlodawska 1 ; Lukasz Pawlik 2 ; Grzegorz Swiercz 1 1 Jan Kochanowski University in Kielce, Kielce, Poland; 2 Kielce University of Technology, Kielce, Poland Objective : To quantify physiologically implausible values in FetalHQ outputs and explore simple predictors of invalid results. Study Design : Retrospective dataset of 37 fetal examinations (GA 18 + 2–35 + 0 weeks). Export database was screened using plausibility windows: GLS −45 to −5% and FAC 5–70%. Values outside ranges were classified as invalid. Invalid rates and error phenotypes were summarised; GA and Pixel Dimension (mm) were compared between valid vs invalid GLS. Results : Invalid values were frequent. LV GLS was invalid in 11/37 (29.7%): 5/37 (13.5%) were positive and 6/37 (16.2%) were between −5% and 0%. RV GLS was invalid in 8/37 (21.6%): 5/37 (13.5%) positive and 3/37 (8.1%) between −5% and 0%. LV FAC was invalid in 7/37 (18.9%) (5 negative; 2 <5%). RV FAC was invalid in 8/37 (21.6%) (7 negative; 1 <5%). Invalid LV GLS tended to occur with larger Pixel Dimension Left (0.0937 vs 0.0867 mm) and higher GA (24.3 vs 21.8 weeks). Conclusion : A substantial proportion of speckle‐tracking outputs contained physiologically implausible values, supporting the need for automated plausibility checks and standardised QC pipelines before downstream analyses.

Jarmila A. Zdanowicz 1 ; Alice Proto 1 ; Mathias Possner 2 ; Fabienne Schwitz 2 ; Anda‐Petronela Radan 1 ; Daniel Surbek 1 ; Luigi Raio 1 1 Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 2 Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Objective : The maternal cardiovascular system is increasingly recognized as a key factor for proper placental development and function. Pregnancies in women with preexisting heart disease are associated with a higher incidence of placenta‐related complications. The aim of the study was to investigate if placental weight (PW) as a surrogate of normal placental development may be altered in this cohort. Study Design : Our retrospective, single‐center observational study included consecutive singleton pregnancies in women with preexisting heart disease and available PW data, from January 2009 to December 2023. We investigated PW, prevalence of small placentas (< 10 th percentile), and incidence of placenta‐related adverse outcomes such as preterm birth, small for gestational age (SGA), intrauterine growth restriction (IUGR), intrauterine fetal death (IUFD), and hypertensive complications. Results : 99 pregnancies in 75 women with pre‐existing heard disease were included. Of these, the largest group with 48.5% (48/99) was comprised of pregnancies with congenital heart disease (CHD) based on the European Society of Cardiology (ESC) classification. Mean ± standard deviation PW was 512 ± 118 grams, and 47/99 (47.5%) had PW <10 th percentile. At least one placenta‐related adverse outcome occurred in 33/99 (33.3%) pregnancies, with SGA/IUGR being the most frequent (26/99, 26.3%). Notably, the use of beta‐blockers was significantly associated with PW <10 th percentile (46.8% vs. 15.4%, p  = 0.0009), which in most cases was initiated before pregnancy and continued throughout gestation in 76.7%. Conclusion : In our cohort, nearly half of the placentas were SGA/IUGR, with a more pronounced effect in women using beta‐blockers. These findings highlight the impact of an altered maternal cardiovascular system on placental development and function and suggest that beta‐blocker use may have an additional negative effect, which should be taken into consideration during antenatal care in this cohort.

Elvira Di Pasquo 1 ; Silvio Tartaglia 1 ; Alessandra Familiari 2 ; Alice Dal Miglio 1 ; Beatrice Valentini 1 ; Enrico Corno 3 ; Maria Teresa Baffa 3 ; Andrea Dall'Asta 3 ; Veronica Falcone 4 ; Farr Alex 4 ; Ruben Ramirez Zegarra 5 ; Stefania Fieni 3 ; Serafina Perrone 3 ; Giovanni Vento 1 ; Tullio Ghi 6 1 IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; 2 IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Rome, Italy; 3 University of Parma, Parma, Italy; 4 Medical University of Vienna, Vienna, Austria; 5 University Hospital Basel, Basel, Switzerland; 6 Department of Woman and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Objective : To identify clinical predictors of delivery within 24 hours after MgSO 4 administration in women with threatened preterm labor. Study Design : This retrospective multicentre cohort study included women with singleton pregnancies between 23 + 0 and 32 + 0 weeks’ gestation admitted with threatened preterm labor and receiving MgSO 4 for fetal neuroprotection across three tertiary maternity units in Italy and Austria between January 2018 and May 2025. The primary outcome was delivery within 24 hours of MgSO 4 initiation. Multivariable logistic regression identified independent predictors. In a secondary analysis restricted to vaginal deliveries, time‐to‐delivery was assessed using Cox proportional hazards models and Kaplan–Meier analysis. Results : Among 357 women (mean gestational age at treatment 27.1 weeks), 273 (76.5%) delivered within 24 hours of MgSO 4 administration, while 84 (23.5%) remained undelivered beyond 24 hours. On multivariable logistic regression, greater cervical dilation at admission (OR 1.17 per cm; 95% CI 1.03–1.33) and higher uterine contraction frequency (OR 1.12 per contraction per 30 minutes; 95% CI 1.04–1.20) were independently associated with delivery within 24 hours. Optimal thresholds were cervical dilation ≥3 cm and ≥6 contractions per 30 minutes. Among the 216 women (60.5%) achieving vaginal delivery, time‐to‐delivery analysis confirmed that both cervical dilation (HR 1.13; 95% CI 1.06–1.20) and contraction frequency (HR 1.11; 95% CI 1.07–1.16) were significantly associated with shorter latency to delivery. Clear risk stratification emerged when these parameters were combined with the shortest latency occurred when both factors were present (Figure 1). Conclusion : A simple bedside combination of cervical dilation ≥3 cm and ≥6 contractions per 30 minutes identifies women at extremely high risk of delivery within 24 hours. This approach may support more accurate timing of magnesium sulfate administration, maximizing neuroprotective benefit while minimizing unnecessary exposure.

Elvira Di Pasquo 1 ; Beatrice Valentini 1 ; Elena Pansoni 2 ; Sara Cicarilli 2 ; Federica Totaro Aprile 2 ; Silvia Salvi 3 ; Tullio Ghi 4 1 IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; 2 Catholic University of the Sacred Heart, Rome, Italy; 3 Università Cattolica del Sacro Cuore, Rome, Italy; 4 Department of Woman and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Objective : To assess whether first‐trimester biochemical and Doppler markers differ between pregnancies that develop fetal growth restriction (FGR), small‐for‐gestational‐age (SGA) fetuses, and whether they can retrospectively discriminate FGR from appropriate fetal growth. Study Design : Retrospective cohort study including singleton pregnancies undergoing routine first‐trimester screening at 11–13 weeks’ gestation. Maternal characteristics, crown–rump length (CRL), mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI), pregnancy‐associated plasma protein‐A (PAPP‐A) and free β‐hCG were recorded. Neonatal outcomes were retrospectively classified as FGR, SGA or AGA based on birthweight percentiles and Doppler findings. Maternal characteristics and first‐trimester markers were compared between groups. Results : A total of 987 normotensive pregnancies were included: 33 FGR, 89 SGA and 865 AGA. Pregnancies that subsequently developed FGR showed significantly lower PAPP‐A MoM compared with both SGA and AGA groups (0.75 ± 0.49 vs 1.15 ± 0.61 and 1.13 ± 0.65, respectively; p  < 0.001). Uterine artery PI MoM was significantly higher in FGR compared with AGA pregnancies (1.16 ± 0.36 vs 1.00 ± 0.30; p  = 0.025) and in SGA compared to AGA pregnancies (1.13 ± 0.4 vs 1.0 ± 0.3). The distribution of cases according to PAPP‐A percentiles showed a clear gradient for FGR, with the highest proportion observed in the lowest PAPP‐A category (< 10° percentile). In contrast, SGA cases were more evenly distributed across PAPP‐A categories (Figure 1). Among 121 fetuses with a weight percentile <10° a cut‐off value of 1.0 MoM had a sensitivity of 90.6% (95% CI 74.9–98.0) and a specificity of 48.3% (95% CI 37.6–59.2) in identifying those fetuses developing FGR. Conclusion : First‐trimester biochemical and Doppler markers show a distinct profile in pregnancies that subsequently develop FGR and can retrospectively discriminate FGR from AGA neonates. These findings support the concept that FGR is associated with early placental dysfunction, whereas SGA represents a different biological entity.

Anushka Pande 1 ; Emily B. Rosenfeld 2 ; Rachel Lee 3 ; Minxiu Shi 4 ; Cande V. Ananth 4 1 Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 2 Division of Maternal‐Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 3 Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 4 Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Brunswick, NJ Objective : Chronic hypertension in pregnancy is associated with long‐term kidney disease. However, its relationship with kidney disease in the immediate postpartum period remains unclear. We examined the association between chronic hypertension in pregnancy and early postpartum kidney disease readmission. Study Design : We conducted a population‐based retrospective cohort study using the Nationwide Readmissions Database (2010–2020) that included women aged 15 to 54 years. The primary outcome was in‐hospital mortality or kidney disease readmission, including acute kidney injury (AKI) and chronic kidney disease (CKD), within the calendar year of delivery. Associations were estimated using adjusted Cox proportional hazards models. Sensitivity analyses examined kidney disease hazards associated with superimposed preeclampsia. Results : Among 16,128,153 delivery hospitalizations, 346,279 (2.1%) were complicated by chronic hypertension. Kidney disease readmission in the calendar year of delivery was more frequent following chronic hypertension than normotensive pregnancies (555 vs 198 per 100,000 deliveries; rate difference, 358 [95% CI, 320–395]). Chronic hypertension was associated with increased hazards of kidney disease readmission (adjusted hazard ratio [HR], 2.22; 95% confidence interval [CI], 2.07–2.39), including AKI (HR, 2.29; 95% CI, 2.09–2.53), CKD (HR, 5.70; 95% CI, 5.87–8.59), and kidney disease‐related in‐hospital mortality (HR, 2.58; 95% CI, 1.48–4.49). AKI and CKD risk were highest within 30 days postpartum (Figure 1). Superimposed preeclampsia was associated with five‐ and thirty‐fold increased hazards of AKI and CKD, respectively, compared with normotensive patients (Table 1). Conclusion : Chronic hypertension in pregnancy was associated with increased hazards of kidney disease readmission and mortality during the calendar year after delivery, with greater risks among those with superimposed preeclampsia. Chronic hypertension may serve as a sentinel risk marker for short‐term postpartum kidney disease.

Elie Azria 1 ; Diane Naouri 2 ; Camille Lauden 3 1 Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics, Obstetric Perinatal and Paediatric Life Course Epidemiology Team OPPaLE, iWISH, F‐75004 Paris, France, Paris, France; 2 AP‐HP (Assistance Publique–Hôpitaux de Paris), Paris, France; 3 Inserm (the French National Institute of Health and Medical Research), Paris, France Objective : Inequalities in maternal and perinatal health remain a major public health concern in France. Prenatal care reduces maternal and neonatal morbidity, yet women facing social disadvantage—particularly those born outside France—remain at higher risk of suboptimal care. Previous studies have examined individual and territorial determinants of suboptimal prenatal care separately, but their joint contribution has not been assessed. We evaluated how individual and territorial factors interact with suboptimal prenatal care and identified profiles of women. Study Design : We conducted a nationwide retrospective cohort study using the EDP‐Santé database, linking individual social information (including tax and civil status data) and health administrative data. The study included women with a delivery stay in the national health insurance system in metropolitan France (2015–2020). Prenatal care adequacy was assessed using an algorithm based on national recommendations. Factorial analysis and clustering identified profiles. Logistic regression models estimated associations with suboptimal prenatal care, overall and stratified by maternal birthplace. Results : Overall, 34% of the 181 937 women included received suboptimal prenatal care. Five profiles were identified. The lowest rate was observed among predominantly French‐born women with more favorable socioeconomic conditions (27%), and the highest among predominantly Sub‐Saharan African–born women with marked socioeconomic disadvantage (57%). Low income, lack of complementary health insurance and residence in deprived municipalities were consistently associated with higher odds of suboptimal care, with stronger associations among foreign‐born women. A clear social gradient was observed across and within municipal deprivation levels. Conclusion : Suboptimal prenatal care in metropolitan France disproportionately affects women facing multiple social, migratory, and territorial disadvantages. These disparities point to social and administrative barriers as key drivers and highlight the need for early outreach and better coordination of health and social services.

Megan Stevenson 1 ; Joe El‐Khoury 1 ; Caitlin Partridge 2 ; Lisbet S. Lundsberg 2 ; Jennifer F. Culhane 2 ; Katherine Kohari 1 1 Yale School of Medicine, New Haven, CT; 2 Yale University, New Haven, CT Objective : We sought to compare testing characteristics and clinical outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) who underwent total bile acid (TBA) enzymatic assay vs fractionated BA testing. Study Design : This retrospective cohort study compared patients with ICP diagnosed by TBA enzymatic assay (rapid test) vs those who had fractionated BA testing (send out test). Data was collected from a single academic healthcare system from 2012–2025 and included all pregnant patients diagnosed with ICP through a BA test result of ≥11 µmol/L. The rapid test is a special institution‐specific assay that results in ∼4 hours while the send out test results in 7–10 days. Patient demographics, test characteristics, disease severity, and perinatal outcomes were collected. Binary and categorical variables were compared by chi‐square or Fisher exact tests as appropriate while continuous variables were compared by Wilcoxon rank‐sum test. Results : 4501 pregnant people underwent BA testing during this time: 2026 via sent out and 2475 via rapid test. There were 1135 cases (25.2%) with positive results with positivity rates of 29.3% ( n  = 726) and 20.2% ( n  = 409) for rapid and sent out tests respectively.(Table 1) Patients diagnosed via rapid test had lower TBA at diagnosis (median 18.0 vs 22.1, p  < 0.0001), lower peak TBA (median 21.0 vs 23.0, p  = 0.023), lower peak AST (median 44.0 vs 55.0, p  = 0.0002), lower peak ALT (median 47.0 vs 80.5, p  < 0.0001), and a higher number of BA tests (median 2.0 vs 1.0, p  < 0.0001) compared to the send out group.(Table 1) The rapid test group delivered later (GA median 37.6 vs 37.1 weeks, p  < 0.0001) and had higher birthweight (median 3109.9 g vs 3030.0 g, p  = 0.0005) compared to the send out group.(Table 2) There was no difference in gestational age at diagnosis, time from diagnosis to delivery, rates of cesarean delivery, 5 min APGAR <7, stillbirth, or NICU stay. Conclusion : Access to a rapid BA assay allows for prompt diagnosis, serial BA testing, and may allow diagnosis of milder cases of ICP to guide obstetric management while achieving similar perinatal outcomes.

Tania M. Hodges 1 ; Dr.Oksana Kaleinikova 2 ; Dr. Anatoliy Maslyukov 2 1 International European University‐Faculty of Medicine, Kyiv, Ukraine; 2 International European University‐Department of Morphology and Physiology, Kyiv, Ukraine Objective : To assess the prevalence and treatment outcomes of vaginal infections in pediatric patients and to evaluate the influence of maternal health factors, particularly gestational diabetes mellitus (GDM), alongside body mass index (BMI), hygiene practices, and environmental conditions in Southeast Asia. Study Design : A randomized controlled trial was conducted in a Southeast Asian family clinic including children aged 4–12 years with confirmed vaginal infections. Participants were stratified by age and maternal gynecological history. Interventions included metronidazole (Metrogyl Gel), oral metronidazole, cefixime, and chlorpheniramine, compared with placebo. Hygiene education was provided, and BMI and maternal history, including GDM, were recorded. Results : Metronidazole gel (Metrogyl Gel) showed the highest efficacy with 75% symptom resolution and 65% infection clearance, followed by oral metronidazole (70%, 60%), cefixime (65%, 55%), chlorpheniramine (50%, 45%), and placebo (35%, 30%). Higher BMI was associated with poorer treatment outcomes. Children of mothers with a history of GDM demonstrated increased susceptibility to infections and reduced treatment response. Poor hygiene practices and humid environmental conditions further contributed to infection persistence. Conclusion : Pediatric vaginal infections in Southeast Asia are influenced by multifactorial determinants, including maternal health. The maternal–fetal link, particularly maternal GDM, appears to predispose children to higher infection risk and poorer outcomes. Metronidazole gel was the most effective treatment. Integrated strategies addressing maternal history, BMI, hygiene education, and environmental factors are essential for improved management and prevention.

Cameron Bernstein 1 ; Sarah A. Olsen 2 ; Rachel Flowers 1 ; Cameron Shults 1 ; Sonia Ter‐Saakyan 1 ; Hannah H. Jordan 3 ; Frank B. Williams 4 1 University of Queensland‐Ochsner Clinical School, New Orleans, LA; 2 Ochsner Clinical School, New Orleans, LA; 3 Ochsner Clinic Foundation, New Orleans, LA; 4 Ochsner Health, Ochsner Health, LA Objective : Among pregnant patients screened and treated for iron deficiency anemia (IDA), we hypothesize that social determinants of health (SDoH) are associated with suboptimal response to iron supplementation. Study Design : We identified pregnant patients receiving prenatal and delivery care across 16 hospitals in a large regional medical system from 2021–2025 that were diagnosed with iron deficiency anemia between 25–30 weeks gestation. Comorbidities associated with impaired iron repletion, undocumented iron treatment, and incomplete data for hemoglobin (Hgb), hematocrit (Hct), or social determinants were excluded. Baseline and pregnancy characteristics were assessed, including payor status and home address Area Deprivation Index (ADI) national centile. The primary outcome was persistent IDA at delivery admission, defined as Hgb <11 g/dL or Hct <33%. A logistic regression model predicting IDA at delivery included 6 maternal characteristics, including ADI centile, public payor, and iron treatment modality. Results : Among 4311 patients with mid‐pregnancy IDA, 2840 had documented treatment with supplemental iron. Mean mid‐pregnancy Hgb was 9.61 g/dL. Mean maternal age at delivery was 29.4 years. 36.5% of treated patients were nulliparous. 58.6% of patients reported Black race. 61.8% of patients were on public insurance. Mean ADI centile was 62.7. Persistent IDA at delivery admission despite prescribed iron was common ( n  = 2035, 71.7%). In regression analysis, ADI percentile and public insurance were independently associated with persistent IDA at delivery, with higher ADI percentile (aOR = 1.007, 95% CI 1.003–1.012) and public insurance (aOR = 1.833, 95% CI 1.498–2.243) linked to higher likelihood of persistent anemia despite treatment. Escalation of IDA treatment to intravenous iron was associated with reduced IDA at time of delivery (aOR = 0.673, 95% CI 0.505–0.902). Conclusion : Neighborhood deprivation and public insurance were predictors of persistent IDA in pregnancy despite supplementation. SDoH may inform strategies to accelerate transition from oral to intravenous iron supplementation.

Alexandra Berezowsky 1 ; Erin Harrington 1 ; Joel G. Ray 1 ; Nir Melamed 1 ; Beth Murray‐Davis 2 ; Sarah D. McDonald 2 ; Jon F. Barrett 2 ; Michael P. Geary 1 ; Howard Berger 1 1 University of Toronto, Toronto, Canada; 2 McMaster University, Hamilton, Canada Objective : To develop and internally validate a multivariable model predicting, among individuals with gestational diabetes mellitus (GDM) initially controlled with lifestyle modification (LM), the risk of later requiring pharmacologic therapy. Study Design : Retrospective single‐centre cohort study at a tertiary Diabetes in Pregnancy clinic in Toronto (2009–2019). Eligible participants had singleton pregnancies with GDM diagnosed at 24 + 0–27 + 6 weeks using a two‐step approach (50 g glucose challenge test followed by 75 g OGTT). Individuals were included if, after a 7–14 day LM trial, they remained on LM at the first clinic visit; those requiring immediate pharmacotherapy were excluded. Outcome : Late LM failure, defined as initiation of insulin and/or metformin after the first clinic visit. Predictors : Prespecified, routinely available variables at the first visit: maternal demographics and history (BMI, ethnicity, parity, prior GDM and prior pharmacotherapy), gestational age at first visit, and GCT/OGTT glucose values. Sample : 691 individuals; 113 (16.6%) experienced late LM failure. Model development and validation : Multivariable logistic regression. Discrimination assessed using AUC. A low‐risk threshold was selected to prioritize sensitivity and minimize missed cases. Internal validation used bootstrap resampling with optimism correction. Results : The final model (BMI, ethnicity, parity, gestational age, prior GDM and pharmacotherapy, and glucose values) achieved an AUC of 0.773 (95% CI 0.710–0.837). At a 7.6% risk threshold, sensitivity was 95.3% and specificity 36.9%. Performance decreased in the testing cohort (AUC 0.621, 95% CI 0.478–0.764). Optimism‐corrected AUC was 0.738 (95% CI 0.692–0.785). Conclusion : A simple model using routinely available clinical and biochemical variables can identify individuals with GDM at low risk of requiring later pharmacotherapy after initial LM control. External validation is required prior to clinical implementation.

Alexandra Berezowsky; Noam Pardo; Anat Pardo University of Toronto, Toronto, Canada Objective : Pregnancy is a critical period during which gestational weight gain (GWG) significantly influences maternal and offspring health. Excessive GWG is associated with adverse outcomes—including gestational diabetes, pre‐eclampsia, and cesarean delivery—as well as long‐term metabolic risk. Despite established guidelines, gaps persist in provider counselling and patient knowledge, limiting awareness of individualized GWG targets. As a modifiable risk factor, GWG represents an important opportunity for intervention, yet counselling and lifestyle support remain inconsistent. We evaluated the gaps between GWG guidelines and real‐world practice at St. Michael's Hospital, focusing on provider counselling and patient knowledge. Study Design : From October–December 2025, an anonymous survey was administered to pregnant individuals with singleton pregnancies <28 weeks’ gestation attending obstetric clinics. The survey assessed GWG, counselling experiences, and knowledge of GWG‐related risks. Results : Fifty‐six individuals participated. Mean maternal age was 32.7 years and mean pre‐pregnancy BMI 24.9 kg/m 2 . Participants had completed ∼65% of pregnancy but had already reached 173% of recommended total GWG. Only 23.2% were within targets, and 14.3% knew their individualized GWG goal. Most participants (66.1%) reported no GWG discussion with a provider. Among those counselled, 32.1% spoke with a physician, 5.4% with a nurse, and 1.8% with a dietitian. No respondents received a clearly defined GWG target, and only 12.5% were offered dietitian referral. Knowledge gaps were substantial, with most unaware of risks associated with abnormal GWG. Interest in additional support was high, including individualized targets (73.2%), nutrition counselling (62.5%), physical activity guidance (62.5%), and dietitian support (32.1%). Conclusion : A substantial gap exists between the importance of GWG and its implementation in practice, reflected by limited counselling, poor patient knowledge, and lack of individualized guidance.

Shreya Shah 1 ; Rebeca Ruiz Roman 2 ; Kypros Nicolaides 2 1 King's College London, London, United Kingdom; 2 Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom Objective : This systematic review aimed to evaluate long‐term outcomes of neonates who have undergone fetal endoscopic tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH). Despite advances in prenatal diagnosis and neonatal care, CDH remains associated with substantial mortality. Most existing studies focus primarily on survival or short‐term neonatal outcomes, with long‐term outcomes often reported inconsistently, descriptively, or as secondary endpoints. Study Design : PubMed, MEDLINE, Embase, and Cochrane CENTRAL were searched from inception to October 2025 for studies reporting outcomes ≥1 year post‐FETO. Quality was assessed using the Cochrane risk‐of‐bias 2 tool and Newcastle‐Ottawa Scale. Meta‐analysis was not performed due to substantial clinical and methodological heterogeneity and a narrative synthesis was carried out instead. Results : Fourteen studies (1 RCT, 13 cohort studies) including 395 infants were analyzed. Follow‐up ranged from 12–72 months. Respiratory complications were most prevalent, though most improved over time. Growth failure affected a proportion of infants at 1 year but demonstrated catch‐up growth by 2 years. Gastrointestinal morbidity (GERD 10–50%, hernia recurrence 21–43%) was common. Neurodevelopmental outcomes were generally reassuring. Multiple studies found no significant differences between FETO and non‐FETO groups after adjusting for disease severity. Conclusion : FETO‐treated CDH survivors experience substantial but improving multisystem morbidity that may be driven by factors independent of the intervention itself, emphasizing the need for long‐term multidisciplinary follow‐up.

Karen P. Becker; Nicol Brandon; Lisa Allen; James Bushby; Vijith Venugopalan; Kiran B; Kalaivanani Manickam; Amie Robinson; John Beard GE HealthCare, Patient Care Solutions (PCS), Waukesha, WI Objective : Twin pregnancies pose unique monitoring challenges. We assessed whether clinicians could reliably identify and interpret two independent fetal heart rate (FHR) tracings acquired with a developmental maternal‐fetal monitoring system (GE HealthCare, Waukesha, WI, USA), and distinguish maternal pulse rate from FHR during monitoring. Study Design : Open‐label, retrospective reader study of 15 antepartum EFM tracings from a single site in a prospective, nonrandomized research study. Two registered nurses and two physicians independently reviewed 40‐minute segments for 15 subjects (60 interpretations). Readers assessed presence of two distinct FHR tracings, baseline, and differentiation of FHR from maternal pulse. Results : All readers (100%) distinguished FHR1 from FHR2, supporting separation of twin fetal heart rate signals. Continuous interpretability of both FHRs was reported in 96.67% of FHR over 40‐minute tracing. Baseline was determined in 95.00% (FHR1) and 96.67% (FHR2). In 10% (6/60), readers requested more FHR data to make clinical decisions when tracings were indeterminate. For the secondary objective, clinicians distinguished maternal pulse rate from FHR in 100% of interpretations, reducing risk of maternal–fetal signal misclassification. Conclusion : This reader study shows clinicians can reliably identify and interpret twin antepartum EFM tracings with two independent heart rates and distinguish them from maternal pulse.

Almira A. Albarido 1 ; Maria Cecilia Magadia 2 On behalf of Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium 1 Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium, Makati, Philippines; 2 Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium, Caloocan City, Philippines Objective : To identify the prevalence of Long‐Acting Reversible Contraception (LARC) use among teenage mothers who delivered at Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium to help enhance future family planning programs. To describe the demographic profile of teenage mothers who delivered at Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium. To identify the determinants of long‐acting reversible contraception (LARC) initiation among teenage mothers who delivered at Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium. To identify the percentage of Intrauterine Device Acceptor and Progestin Subdermal implant acceptor among teenage mothers who delivered at Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium. Study Design : This research used a descriptive cross‐sectional design. Results : An extraordinary 98.6% of participants initiated LARC. The cohort was predominantly older adolescents (17–18 years: 52.3%), first‐time mothers (96.3%), single (70.6%), and unemployed (93.6%). The most important determinant for choosing LARC was its efficacy in preventing pregnancy (mean rank: 1.3), followed by its long duration of action (1.4). Family recommendation (1.6) was a stronger facilitator than peer influence (2.0). Affordability and accessibility were equally valued (both 1.5). Conclusion : This study demonstrates that exceptionally high uptake of Long‐Acting Reversible Contraception among teenage mothers is achievable in the Philippine context when a supportive, accessible, hospital‐based intervention is in place. The primary driver is the rational desire to prevent a subsequent pregnancy. Success is facilitated by family support, the removal of cost barriers, and accessible postpartum services. This model effectively translates global health recommendations into local action, offering a tangible, scalable pathway to curb the nation's persistently high adolescent pregnancy rate.

Saowapak Junhasavasdikul 1 ; Rattapa Navespootikorn 2 On behalf of the Department of Obstetrics and Gynecology, Phramongkutklao Hospital Foundation 1 Phramongkutklao Hospital, Phayathai, Thailand; 2 Somdech Phranangchao Sirikit Hospital, Chonburi, Thailand Objective : To evaluate the association between placental thickness during the second and third trimesters of pregnancy and neonatal birth weight. Study Design : A prospective descriptive study was conducted at the Department of Obstetrics and Gynecology, Phramongkutklao Hospital, among pregnant women aged 20 years and older who attended the hospital for antenatal care were included. Ultrasound examinations, including measurement of placental thickness, were performed in the second trimester (18–22 weeks of gestation) to screen for fetal structural abnormalities and in the third trimester (28–32 weeks of gestation) to assess fetal growth. Placental thickness was measured using 2D ultrasound to determine placental position and umbilical cord insertion site, with color Doppler mode applied for confirmation. Placental thickness was recorded in millimeters(mm) at the perpendicular midpoint of the umbilical cord insertion. Subsequently, the data were analyzed in relation to neonatal birth weight, the prediction of low birth weight (LBW), pregnancy complications, and other outcomes. Results : A total of 192 participants were assessed for placental thickness in both trimesters. A very weak but statistically significant positive linear correlation was observed between placental thickness and birth weight in the third trimester ( r  = 0.143, p  = 0.048), whereas no significant correlation was found in the second trimester ( r  = 0.114, p  = 0.119). Placental thickness ≤15 mm in the second trimester was significantly associated with an increased risk of LBW (OR = 4.58, 95% CI: 1.10–19.09, p  = 0.037), with a sensitivity of 21.4%, specificity of 94.4%, PPV of 23.1%, and NPV of 93.9%. In contrast, placental thickness in the third trimester was not associated with LBW ( p  = 0.305). Conclusion : Placental thickness shows limited correlation with birth weight, with only a weak association in the third trimester. However, a thin placenta (≤15 mm) in the second trimester is linked to increased risk of low birth weight, suggesting value for early screening, while third‐trimester measurements are not predictive.

Anna Avdeeva National Medical Research Center For Obstetrics, Gynecology And Perinatology Named After Academician, MOscow, Russia Objective : To compare pregnancy complications, delivery outcomes, and perinatal care barriers in neurodivergent women versus matched controls, identifying needs for personalized maternity strategies. Study Design : Retrospective observational study (2015–2025) at National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Moscow. Included 18 women with confirmed neurodevelopmental disorders (primarily autism spectrum) and 21 age/parity/gestational age‐matched controls with uncomplicated pregnancies. Analyzed medical records using chi‐square/Fisher's exact tests and t‐tests/Mann‐Whitney U; p  < 0.05 significant. Results : Neurodivergent women had higher pelvic girdle pain (66.7% vs 23.8%, p  = 0.01), vaginal bleeding (44.4% vs 14.3%, p  = 0.04), anxiety (61.1% vs 19.0%, p  = 0.007), depression (50.0% vs 14.3%, p  = 0.02), persistent nausea (50.0% vs 14.3%, p  = 0.03), and lower prenatal attendance (66.7% vs 95.2%, p  = 0.02). Cesarean rates reached 83.3% vs 23.8% ( p  = 0.001); breastfeeding refusal was 94.4% vs 4.8%. Communication difficulties affected 83.3%; postpartum depression noted in 77.8%. Conclusion : Neurodivergent women face elevated physical/mental health risks and care barriers during perinatal period. Neurodiversity‐informed strategies—sensory accommodations, trauma‐aware communication, mental health integration—are essential for equitable maternity care.

Shalini Mahapatra 1 ; Vivek Krishnan 2 1 Credence Hospital, Thiruvananthapuram, India; 2 Amrita Institute of Medical Sciences, Kochi, India Objective : Objective: Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular anomaly associated with significant perinatal morbidity and mortality. This study evaluated prenatal predictors of neonatal outcome in a single‐centre cohort of 17 fetuses with VGAM, focusing on hemodynamic versus anatomical prognostic markers. Study Design : Methods: We retrospectively analysed 17 consecutive cases of VGAM diagnosed between 27.0‐ and 37.6‐weeks’ gestation (mean 32.7 ± 3.4). Prenatal assessment included VGAM size (mean 295.8 ± 215.9 mm 2 ), tricuspid regurgitation (TR), aortic steal, straight sinus dilatation, and progression of cardiac dysfunction. Postnatal outcomes—mortality and need for intervention—were correlated with prenatal findings. Results : Results: Straight sinus dilatation was universal (100%). TR was present at diagnosis in 41.2% (7/17) and developed later in an additional 17% (3/10). Aortic steal and hydrops occurred at presentation in 35.3% each (6/17). Neonatal mortality was 58.8% (10/17), including 41.2% early neonatal deaths. Postnatal intervention was performed in 7/17 patients (41.2%). Hydrops and aortic steal were significantly associated with early neonatal death (57.1%), while TR showed an even stronger trend (71.4%). Lesion size ≥2 cm did not predict mortality in this series. Straight sinus dilatation >6 mm was seen in 85.7% of early neonatal deaths, emerging as a critical predictor of mortality. Conclusion : Conclusion: Straight sinus dilatation >6 mm and TR are key hemodynamic predictors of early neonatal mortality, challenging the prognostic value of lesion size alone. Serial hemodynamic assessment should be prioritized over static anatomical measurements to improve risk stratification, parental counselling, and timing of intervention. Multicentre validation is warranted.

Zhaniya Alpysbay On behalf of Asfendiyarov Kazakh National Medical University Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan Objective : To systematically evaluate the impact of microgravity and spaceflight stressors on the efficacy of ART, specifically focusing on gamete quality, fertilization success, and genomic stability in early‐stage embryos based on recent scientific evidence. Study Design : This systematic review was conducted according to PRISMA guidelines. A qualitative evaluation of high‐impact studies published between 2019 and 2026 investigating reproductive outcomes and ART in spaceflight and simulated microgravity models was performed. A total of 16 peer‐reviewed studies from the PubMed and Scopus databases, encompassing both preclinical and clinical models, met the predefined inclusion criteria and were included in the final synthesis. Results : Analysis of the 16 biologically diverse studies demonstrated that spaceflight and microgravity induce adverse effects on reproductive cells. Significant findings include the following: In male gametes during human in vitro studies, microgravity was associated with reduced sperm motility, altered capacitation, and an elevated DNA fragmentation index. In preclinical in vivo models, female reproductive function showed compromised ovarian follicle quality, disrupted endocrine signaling, and oocyte maturation arrest. These changes were often linked to mitochondrial hyperpolarization and enhanced oxidative phosphorylation. At the embryonic level of both preclinical and clinical studies, early developmental stages showed potential genomic instability and a higher rate of chromosomal abnormalities. While the fertilization process remains physically possible under microgravity conditions, the cumulative data indicates significantly increased reproductive risks for ART procedures in the space environment. Conclusion : Current analysed evidence suggests that spaceflight stressors pose considerable risks to sexual health and the conception process. As humanity moves toward long‐duration space missions, developing specialized ART protocols and protective strategies for reproductive organs is essential to reduce microgravity‐induced cellular damage and ensure safety in the space environment.

Fabrizio Zullo 1 ; Hector Mendez Figeuroa 2 ; Kristen A. Cagino 2 ; Aaron W. Roberts 2 ; Sara Sorrenti 1 ; Suneet P. Chauhan 3 ; Daniele Di Mascio 1 1 Sapienza University of Rome, Rome, Italy; 2 McGovern Medical School at UTHealth, Houston, TX; 3 ChristianaCare, Newark, DE Objective : There is a paucity of data on maternal adverse outcomes among deliveries complicated by hypoxic ischemic encephalopathy (HIE).We hypothesized that maternal adverse outcomes are significantly higher in deliveries with HIE than without it. Study Design : This is a secondary analysis of Assessment of Perinatal Excellence (APEX), which was a multicenter, prospective observational study collected from 25 centers from 2008–11. The inclusion criteria were non‐anomalous, live‐born, singletons at > 35 weeks, with data on the presence of HIE, defined as ≥3 abnormal findings across six neonatal neurologic examination domains. Composite adverse maternal outcomes (CAMO) included chorioamnionitis, 3 rd or 4 th degree lacerations, blood transfusion, admission to the intensive care unit, hysterectomy, or death. Composite surgical maternal morbidity (CSMM) included ureteral injury, laparotomy, uterine artery ligation, cystotomy, hypogastric ligation, B‐lynch stich, uterine balloon / packing or bowel injury. Multivariable Poisson regression models were used to estimate the association between HIE and adverse outcomes. Adjusted incidence rate ratio (aIRR) with 95% confidence intervals (CI) were calculated. Results : Of the 118,422 deliveries in APEX, 93,031 (78.6%) met the inclusion criteria, and among them, 871 (0.9%) had HIE. Nulliparity was significantly more common in deliveries with HIE than without ( p  < 0.01), as was government‐assisted insurance ( p  = 0.02), hypertensive disorder of pregnancy ( p  < 0.01) and diabetes ( p  < 0.01). Cesarean delivery occurred in 36.3% of those who had HIE, versus 20.0% for those who did not ( p  < 0.01). CMAO was 135% higher in deliveries with (20.1%) versus without HIE (8.5%; aIRR 2.01, 95% CI 1.76–2.29; Table 1). CSMM was 70% higher with HIE (1.1%) than without (0.4%; aIRR 2.65; 95% CI 1.40–4.99; Table 2). Conclusion : Among deliveries with hypoxic ischemic encephalopathy, at least 1 in 5 have maternal complications, which is 135% higher than those without encephalopathy. Intervention trials to decrease hypoxic ischemic encephalopathy should address the potential complications for the parturients.

Fabrizio Zullo 1 ; Jyoti Dubey 2 ; Kristen A. Cagino 3 ; Aaron W. Roberts 3 ; Amalia Brawley 4 ; Kelley Kovatis 5 ; Padmashree C. Woodham 4 ; Suneet P. Chauhan 5 ; Daniele Di Mascio 1 1 Sapienza University of Rome, Rome, Italy; 2 Rutgers University, New Brunswick, NJ; 3 McGovern Medical School at UTHealth, Houston, TX; 4 Medical College of Georgia at Augusta University, Augusta, GA; 5 ChristianaCare, Newark, DE Objective : In low‐risk pregnancies at 37 to 41 wks, neonatal seizure (NS) occurs in 0.2/1,000 live births and is associated with adverse outcomes. There is, however, a paucity of data on neonatal and maternal outcomes in pregnancies complicated by hypertensive disorders (HDP) and subsequent neonatal seizures (NS). We hypothesized that among individuals with HDP at 37 to 41 weeks, NS, compared to no NS, are associated with significantly increased adverse outcomes in the neonatal‐maternal dyad. Study Design : We conducted a population‐based retrospective cohort study using US vital statistics data (2016–2023). We excluded those without labor, delivery 41.6 weeks, malpresentation, diabetes, multiples, anomalies, and no seizure data. The co‐primary outcome was composite neonatal adverse outcome (CNAO;5‐min Apgar 6 hours, or neonatal death) and infant mortality. Secondary outcomes included composite maternal adverse outcome (CMAO; transfusion, ICU admission, uterine rupture, or hysterectomy). Multivariable Poisson regression models were used. Results : Of 29.9 million births, 1.2 million (4.1%) met the inclusion criteria and among them NS occurred in 658 (5 /1,000 live births). Risk factors independently associated with NS included nulliparity (aRR 1.41), smoking (aRR 1.65), obesity (aRR 1.34), chorio (aRR 2.78), cesarean delivery (aRR 2.20), OVD (aRR 3.45), and male sex (aRR 1.52). CNAO occurred in 547.9/1,000 births with seizures versus 17.0/1,000 without (aRR 23.18, 95% CI 21.40–25.10). All individual components—5 min Apgar <5 (aRR 32.52) and neonatal death (aRR 109.56—were significantly higher with than without NS (Table1). CMAO was significantly more common (aRR 5.36, 95% CI 4.00–7.19), as were the components—ICU admission (aRR 9.49) and uterine rupture (aRR 40.11; Table 2). Conclusion : Among pregnancies complicated by HDP, seizures, although uncommon, are associated with increased risks of neonatal and maternal adverse outcomes. While the data is useful for shared‐decision making, trials mitigating adverse outcomes may be problematic considering the infrequent nature of occurrence.

Betty Bretin 1 ; Norbert WINER 2 ; Valérie ROUGER 3 ; Bénédicte Gaillard Le Roux 4 ; Marie Demonceaux 5 ; Thomas Moyon 5 ; Alban‐Elouen Baruteau 6 ; Véronique Ferchaud‐Roucher 5 On behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units Network and the Neonatal Research Network, Bethesda, MD, United States 1 CHU Nantes, Nantes; 2 Department of Obstetrics and Gynecology, CHU Nantes, Nantes Université, Nantes, France; 3 Loire Infant Follow‐Up Team (LIFT) Network, F‐44000 Nantes, France., Nantes, France; 4 Nantes Université, CHU Nantes, Department of Pediatric Intensive Care, Nantes; 5 Nantes Université, CHU Nantes, INRAE UMR 1280 PhAN, Nantes; 6 Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Objective : Congenital heart disease (CHD) is the most common fetal malformation and a leading cause of childhood neurodevelopmental disorders (NDD) in children. While CHD severity is traditionally considered the main determinant of neurodevelopmental outcomes, increasing evidence suggests that the maternal environment during pregnancy may play a critical role. Indeed, an adverse maternal environment that leads to placental insufficiency may cause heart defects and brain damages in utero. Objectives : We investigated the association between maternal risk factors, and long‐term neurodevelopment in children with CHD. Study Design : We conducted a French multicenter retrospective cohort study including 334 women who delivered infants with CHD between 2012 and 2023. For a third of them, children underwent standardized neurodevelopmental assessments at ages 2, 5, and 7 years. CHD severity was categorized as critical‐complex, non‐critical complex, or non‐complex depending on anatomical defect and time to surgery. Multinomial multivariable logistic regression examined associations between maternal factors and CHD severity. Secondary analyses evaluated the relationship between CHD severity and NDD and assessed maternal predictors of NDD accounting for CHD severity. Results : Maternal psychological distress (OR 0.39, 95% CI 0.18–0.87) and nulliparity (OR 1.77, 95% CI 1.08–2.90) were associated with lower odds of severe CHD. CHD severity was not associated with NDD at ages 2, 5, or 7 years. However, maternal characteristics including being younger than 25 or older than 30 years, multiparity, and gaining gestational weight more than 12 kg were associated with higher risk of combined CHD and NDD outcomes. Conclusion : Our study is the first to demonstrate the associations between specific maternal environmental risk factors and NDD in CHD infants when considering CHD severity. These findings highlight the importance of maternal health and prenatal environment in shaping long‐term outcomes and support systematic neurodevelopmental surveillance for children with CHD regardless of lesion severity.

Lauret A.M. Brinkman 1 ; Monique C. Haak 2 ; Sanne J. Gordijn 3 ; Charlotte M. H. H. T. Bootsma‐Robroeks 4 ; Valentina Gracchi 4 ; Jaap Mulder 5 ; Lisette 't hoen 6 ; Rianne J. M. Lammers 7 ; Caterina M. Bilardo 8 ; Eva C. Weber 9 ; Federica Fontanella 8 1 UMC Groningen, Groningen, Netherlands; 2 Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands; 3 UMCG, Groningen, Netherlands; 4 Department of Pediatric Nephrology, University Medical Center Groningen, Groningen, Netherlands; 5 Department of Pediatric Nephrology, Leiden University Medical Center, Leiden, Netherlands; 6 Department of Pediatric Urology, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands; 7 Department of Urology, University Medical Center Groningen, Groningen, Netherlands; 8 Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, Netherlands; 9 Department of Obstetrics, Faculty of Medicine, University Hospital Cologne, Cologne, Germany Objective : Fetal Lower Urinary Tract Obstruction (LUTO) is a rare congenital anomaly with significant perinatal morbidity and mortality, and long‐term renal and bladder dysfunction. Fetal interventions, including vesico‐amniotic shunt (VAS) placement and fetal cystoscopy, aim to reduce urinary tract pressure to improve survival and outcomes. Although VAS is the earliest established fetal intervention in medical history, its effectiveness in improving long‐term outcomes remains unclear. Moreover, evidence on optimal patient selection and timing of intervention is limited, and large international collaborative studies are lacking. The objective of the RESUME study is to investigate perinatal and long‐term (renal) outcomes in fetuses with LUTO treated with fetal intervention versus conservative management. Study Design : RESUME is an international, multicenter, retrospective observational study including fetuses with LUTO who underwent VAS or fetal cystoscopy at any gestational age between 2004–2024, and a conservatively managed cohort. The primary endpoint is postnatal renal function (serum creatinine nadir within the first year of life) and secondary endpoints include gestational age at intervention, long‐term renal/ bladder outcomes, and complication rates. Results : Currently, 42 fetal therapy centers worldwide have confirmed participation, establishing RESUME as the largest international collaborative study in fetal therapy for LUTO, but new centers are welcome to join until end 2026. We encourage international participation to maximize sample size, capture global variations in clinical practice, and improve generalizability. Conclusion : The RESUME study represents an unprecedented international effort to address the uncertainty surrounding the effectiveness of fetal therapy for LUTO. In a rare condition where RCTs are challenging, this collaboration offers the best available evidence. By harmonizing data and expanding global participation, RESUME aims to clarify when, for whom and how fetal intervention is beneficial, guiding evidence‐based care and improving outcomes for children with LUTO.

Corinne Parker 1 ; Erkan Kalafat 2 ; Pepper Katherine 1 ; Rebecca Horgan 1 ; Jerri A. Waller 1 ; George R. Saade 1 ; Marwan Maayeh 1 1 Eastern Virginia Medical School at Old Dominion University, Norfolk, VA; 2 Koç University Hospital, Istanbul, Turkey Objective : To evaluate the association between glycemic variables on continuous glucose monitoring (CGM) and adverse maternal outcomes in patients with Type 1 diabetes mellitus (T1D). Study Design : This was a retrospective observational study of all pregnant individuals with T1D using a CGM at a single tertiary care center between 2014 and 2025. Glycemic metrics assessed included time in range (TIR), defined as the percentage of time with a blood glucose of 60–140 mg/dL, mean glucose values, and first and second trimester HgbA1C. First and second trimester data was included in the analysis. The primary outcome was a composite of adverse maternal outcomes which included postpartum hemorrhage, thromboembolism, acute kidney injury, intensive care admission, and maternal death. Associations were tested using univariable and multivariable regression analyses. Results : A total of 179 pregnancies amongst 169 patients were included. Patient clinical characteristics, including maternal age, race, body mass index, insulin pump use, and chronic hypertension were not associated with a difference in the composite of adverse maternal outcomes. In the multivariable model, first and second trimester CGM parameters, including TIR, time very high (>180 mg/dL), average glucose, and Hemoglobin A1c were not significantly associated with risk of our composite maternal outcome, nor were maternal clinical factors including age, body mass index, race, insulin pump use, and chronic hypertension (Table 1). Conclusion : In pregnancies complicated by T1D, first and second trimester CGM metrics were not associated with risk of adverse maternal outcomes. These findings suggest that early pregnancy glycemic measures may have limited utility for maternal risk stratification, although confirmation in larger cohorts is warranted.

Aradhana Singh 1 ; Rachan Kour 2 ; urja sinha 3 1 All India Institute of Medical Sciences (AIIMS), Gorakhpur, Gorakhpur, India; 2 All India Institute of Medical Sciences (AIIMS), Gorakhpur, Gorakhpur; 3 Baba Raghav Das Medical College, Gorakhpur, India Objective : Primary Objective To identify clinical, demographic, and diabetes‐related determinants associated with adverse maternal and perinatal outcomes in pregnancies complicated by diabetes. Secondary objective To determine independent predictors of adverse maternal and perinatal outcomes using multivariable regression analysis. Study Design : A retrospective cohort study was conducted at a tertiary care centre from July 2024 to January 2026. Records of 297 pregnant women diagnosed with diabetes in pregnancy were reviewed. Variables analyzed included maternal age, BMI, parity, booking status, type of diabetes, gestational age at diagnosis, treatment modality, co‐morbidities, and family history. Primary outcomes included caesarean delivery, preterm birth, macrosomia, and stillbirth. Associations were evaluated using chi‐square analysis. Determinants were assessed using logistic regression. Results : Of 297 women, 233 (78.4%) had GDM, 49 (16.5%) overt diabetes, and 15 (5.1%) pre‐gestational diabetes. Pharmacologic therapy was required in 121 (40.7%). Caesarean delivery occurred in 152 cases (51.2%). Preterm birth (24.9 kg/m 2 ), requirement of pharmacologic therapy, presence of co‐morbidities, and unbooked status. Conclusion : Adverse maternal and perinatal outcomes in pregnancies complicated by diabetes are influenced by interacting clinical and demographic determinants rather than diagnosis alone. Maternal adiposity, requirement of pharmacologic therapy as a marker of greater metabolic severity, and the presence of co‐morbidities independently predicted caesarean delivery, preterm birth, and macrosomia in this tertiary care cohort. These findings support a determinant‐based risk stratification approach to diabetic pregnancies. Early identification of high‐risk subgroups and implementation of structured, intensified antenatal monitoring may reduce preventable morbidity and improve maternal and neonatal outcomes in high‐burden settings.

Kelly S. Gibson The MetroHealth System, Cleveland, OH Objective : Delivery between 20 and 25 weeks is uncommon. Mode of delivery may impact neonatal survival and maternal morbidity at these gestational ages. We sought to compare maternal and neonatal outcomes by mode of delivery at periviable gestations. Study Design : A prospective 12 hospital multicenter cohort study of in‐hospital deliveries at 20w0d‐25w6d gestation with documented fetal heart rate on admission from May 2024‐April 2025. Postpartum maternal outcomes included hemorrhage, total blood loss, and blood product transfusion. Neonatal outcomes included survival to discharge and severe neonatal morbidity. Results : Of 480 pregnant patients and their 535 fetuses, 200 were delivered by cesarean (CD) and 280 by vaginal delivery (VD); 452 (84.5%) were liveborn. Patients who delivered by CD were more likely to be multiparous, have adequate prenatal care, higher BMI, later gestational age and less likely to be in spontaneous labor. Vertical uterine incision was performed in 119 (60.4% of CD). CD were associated with a higher total blood loss (adj. median diff (95% CI) 440 mL (386–494)) and blood product transfusion (21 v 8.9%; aOR 2.53 (1.39–4.59)). CD was significantly more likely at 22–25w (54% of deliveries), while 97% of 20–21w deliveries were vaginal. Neonatal survival differed by week of gestation but not mode of delivery (0% at 20w to 75.6% via CD and 75.7% via vaginal at 25w; aOR 1.42 (0.82–2.44)). Antenatal steroid administration from 20–25w increased from 0 to 94% while intrapartum stillbirths decreased from 56 to 0%. Among all infants who survived to discharge, there was no difference in severe neonatal morbidity by mode of delivery (64.9 CD v 64.4% VD; aOR 1.42 (0.74–2.71)). Conclusion : At 20–25 weeks’ gestation, CD was associated with increased maternal blood loss and a higher rate of vertical uterine incisions. Mode of delivery was not associated with morbidity amongst neonates surviving to discharge.

Alice Beardmore‐Gray 1 ; Christa Ingrid Rohwer 2 ; Cristina Fernandez Turienzo 1 ; Catherine Cluver 3 1 King's College London, London, United Kingdom; 2 Gothenburg University, Sahlgrenska Academy, Gothenburg University, Sweden; 3 Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa Objective : To assess the benefits and harms of planned early birth versus expectant management in pregnant women ≥34 weeks’ gestation with hypertensive disorders. Study Design : We conducted a Cochrane systematic review to evaluate randomised controlled trials (RCTs) comparing planned early birth with expectant management for women ≥34 weeks’ gestation with hypertensive disorders. The critical outcomes were a composite of maternal mortality and morbidity, a composite of perinatal mortality and morbidity, maternal death, fetal death and neonatal death. We searched four electronic databases and clinical trial registries to identify eligible studies. Two authors independently selected studies, assessed trustworthiness, extracted data, and assessed risk of bias of included RCTs. We conducted meta‐analysis where data was sufficiently homogeneous and assessed certainty of evidence using GRADE. Results : We included six RCTs involving 3491 women. Four RCTs evaluated planned early birth between 34–37 weeks, one at 36–38 weeks, and one at 36–41 weeks. One RCT was conducted in low and middle income‐countries, and five in high income‐countries. Overall, risk of bias across outcomes was low in five RCTs. Planned early birth reduces risk of maternal mortality and morbidity compared to expectant management with no increased risk of caesarean section. Planned early birth likely results in a large reduction in the risk of stillbirth and probably results in little to no difference in rates of neonatal unit admission. We found little to no difference in maternal death or neonatal death. The evidence is very uncertain about the effect on overall perinatal mortality and morbidity due to high variation between trials. Conclusion : Our review found that planned early birth compared to expectant management was beneficial across outcomes, with no important harmful effects. Further research should assess long‐term infant outcomes associated with late preterm birth and long‐term maternal cardiovascular health.

Eskinder Girmachew Hailegiorgis 1 ; Birhanu Kebede Dina 2 ; Digafe Tesfaye Nigatu 2 On behalf of the Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, School of Medicine, Abebech Gobena MCH of Yekatiti Hospital, Addis Ababa Ethiopia; and the Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia 1 University of Gondar, Gondar, Ethiopia; 2 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia Objective : To determine the prevalence and explore associated factors of episiotomy. Study Design : Cross‐sectional study design. Results : The prevalence of episiotomy is 40.6% [95% CI = (35.2, 45.0)]. Primiparity [AOR = 7.20, 95% CI = (4.20, 7.30)], Previous cesarean delivery (CD) [AOR = 7.10, 95% CI = (3.20,16.20)], Breech [AOR = 4.40, 95% CI = (1.7,11.4)], Operative Vaginal Delivery (OVD) [AOR = 6.20, 95% CI = (2.0,19.3)] were significantly associated. Conclusion : The finding that episiotomies were performed in a significant portion of cases highlights a notable prevalence within the institutions studied. Primiparity, Previous CD, breech, and OVD are all associated with increased odds. This finding highlights why these factors must be considered when assessing the procedure's need and impact.

Iryna Kitova; Olha Fandieieva; Hanna Mostova Dnepropetrovsk Regional Hospitai, Dnipro, Ukraine Objective : Severe combined mine‐blast injuries in pregnant patients present complex clinical challenges, particularly when associated with open penetrating traumatic brain injury (TBI) during the first trimester. Study Design : We report the case of a 14‐week primigravida who sustained a severe combined mine‐blast injury during ballistic shelling of a maternity hospital in Kamianske, Ukraine, on July 29, 2025. The dominant injury was an open penetrating TBI with intracranial hematomas and multiple shrapnel wounds. The patient required urgent neurosurgical intervention, including hematoma evacuation, removal of a metallic fragment, dural repair, and cranioplasty. Despite prolonged anticonvulsant therapy and multiple surgical procedures, a multidisciplinary team elected to continue the pregnancy. Close obstetric and neurosurgical monitoring was maintained throughout gestation. Results : At 40 weeks’ gestation, spontaneous vaginal delivery resulted in the birth of a live male infant weighing 2310 g (length 46 cm). Both mother and newborn had satisfactory postpartum courses and were discharged home on day 4. Conclusion : Severe combined mine‐blast trauma with open penetrating TBI in the first trimester is not an absolute indication for pregnancy termination. With maternal stabilization and coordinated multidisciplinary management, successful prolongation of pregnancy and delivery of a viable term infant are possible.

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