Poster Session 2 : Thursday, 8 October 2026   16:00 – 17:15

Lena Bertozzi 1 ; Ian J. Hooley 2 ; Thomas Galeon 1 ; Eva M. Luo 2 ; Isabelle Von Kohorn 2 1 Pomelo Care, New York, NY; 2 Pomelo Care, Pomelo Care, NY Objective : Emergency Department (ED) utilization during the perinatal period is a significant driver of healthcare spending. Root causes include limited access to 24/7 specialized guidance for maternal complications and neonatal concerns. This analysis evaluates the impact of a 24/7 multispecialty virtual maternity and infant care program on combined maternal‐infant dyad ED spending during pregnancy through 60 days postpartum. Study Design : We conducted a retrospective cohort analysis of 2841 maternal‐infant dyads across three commercial payers with sequential intervention initiation (Jan 2024 ‐ Sept 2025). The intervention offered 24/7 access to a multidisciplinary team providing proactive prenatal care, transition support, postpartum care, and virtual urgent care. We compared dyads who first engaged prenatally ( n  = 402) against a non‐engaged comparison group ( n  = 2,439). Propensity score‐based inverse probability weighting adjusted for imbalances in demographics, insurance, utilization history, and relevant chronic conditions. Post‐weighting balance was assessed using Standardized Mean Differences (SMD). The primary outcome, perinatal episode ED cost for the dyad (280 days pre‐ to 60 days post‐delivery), was assessed using weighted means. Results : Perinatal program engagement was associated with a significant reduction in combined maternal‐infant ED spending (−21.3%, p  < 0.05). This represents an adjusted cost reduction of $481 per dyad with at least one ED visit. With a 94% effective sample size, baseline characteristics were well‐balanced after weighting (SMD <0.1). Conclusion : These findings demonstrate that a virtual care model with prenatal and dyadic postpartum‐infant care is associated with a significant reduction in combined maternal and neonatal ED costs within a commercial population. This highlights the potential for virtual perinatal programs to increase access to continuous care and mitigate reliance on emergency services for non‐emergent concerns, suggesting an opportunity to reduce avoidable ED utilization within this care setting.

Serena M. Jones 1 ; Frank I. Jackson 2 ; Sarah H. Abelman 2 ; Oladunni Ogundipe 2 ; Matthew J. Blitz 2 1 New York Institute of Technology College of Osteopathic Medicine; Northwell Health, Northwell Health, NY; 2 Northwell Health, Bay Shore, NY Objective : To evaluate temporal trends in hysterectomy among births complicated by maternal blood transfusion, overall and by mode of delivery from 2017–2024. Study Design : This was a retrospective national cohort study using U.S. National Vital Statistics System (NVSS) natality data from 2017–2024. Maternal transfusion and unplanned hysterectomy were identified using NVSS maternal morbidity indicators, which capture events occurring during the delivery hospitalization. Analyses were stratified by delivery method. Monthly hysterectomy rates among transfused births were calculated per 1000 transfused births and evaluated using Joinpoint regression. Average monthly per‐thousand change (AMPC) was reported with a 95% Confidence Interval (CI). Results : Among 29,611,120 U.S. births, 143,283 were complicated by maternal transfusion (61,159 vaginal; 82,124 cesarean). The overall hysterectomy rate among transfused births declined from 63.85 to 29.21 per 1000 between January 2017 and December 2024, with a modest initial decline through September 2023 (AMPC −0.42%; 95% CI, −0.53 to −0.09; p  = .043) followed by a steeper decline thereafter (AMPC −1.98%; 95% CI, −9.57 to −0.62; p  < .001; Figure 1). Among transfused vaginal births, hysterectomy rates declined from 44.09 to 8.40 per 1000, with an initial increase through December 2019 (AMPC 1.06%; 95% CI, 0.36 to 2.23; p  = .006), followed by a sustained decline (AMPC −1.32%; 95% CI, −1.81 to −1.01; p  < .001; Figure 2A). Among transfused cesarean births, rates declined from 77.79 to 44.09 per 1000, with a consistent overall decrease and no joinpoint identified (AMPC −0.48%; 95% CI, −0.59 to −0.38; p  < .001; Figure 2B). Conclusion : Hysterectomy among patients requiring a transfusion during childbirth declined from 2017 to 2024 overall and by delivery method. However, rates remained markedly higher among cesarean compared with vaginal births. These findings suggest ongoing opportunities to reduce severe hemorrhagic morbidity through both optimization of hemorrhage management and efforts to avoid potentially preventable cesarean delivery.

Serena M. Jones 1 ; Frank I. Jackson 2 ; Sarah H. Abelman 2 ; Oladunni Ogundipe 2 ; Matthew J. Blitz 2 1 New York Institute of Technology College of Osteopathic Medicine; Northwell Health, Northwell Health, NY; 2 Northwell Health, Bay Shore, NY Objective : To compare route‐specific peripartum hysterectomy rates in the United States and Mexico from 2017–2024. Study Design : This retrospective cohort study used U.S. National Vital Statistics System (NVSS) natality data and Mexico hospital discharge and procedure data from 2017–2024. Peripartum hysterectomy during the delivery hospitalization was identified using the NVSS maternal morbidity indicator (U.S.) and procedure coding (Mexico). Analyses were limited to identified vaginal and cesarean deliveries; nonclassifiable routes were excluded. Monthly hysterectomy rates per 10,000 deliveries were evaluated using Joinpoint regression. Pooled 2017–2024 rates and Mexico‐to‐U.S. rate ratios (RR) with 95% CIs were calculated. Results : A total of 33,383,852 deliveries were included: 29,611,120 in the United States (20,124,465 vaginal; 9,486,655 cesarean) and 3,772,732 in Mexico (3,148,984 vaginal; 623,748 cesarean). In Joinpoint analyses, only the U.S. vaginal series demonstrated a significant joinpoint in December 2021, with increasing rates before and decreasing rates afterward ( p  = 0.007 and p  < 0.001, respectively). Vaginal hysterectomy rates in Mexico increased throughout the study period ( p  < 0.001). Cesarean hysterectomy rates showed no joinpoints and no significant overall trends in either country (U.S. p  = 0.353; Mexico p  = 0.181) (Figure 1). Pooled hysterectomy rates were higher in Mexico than in the United States after both vaginal delivery (3.08 vs 1.46 per 10,000; RR 2.12, 95% CI 1.97–2.28) and cesarean delivery (28.44 vs 11.71 per 10,000; RR 2.43, 95% CI 2.31–2.55) (Figure 2). Conclusion : Peripartum hysterectomy rates were approximately two‐fold higher in Mexico than in the United States after both vaginal and cesarean delivery, with markedly higher rates after cesarean in both countries. The post‐2021 decline in U.S. vaginal hysterectomy rates warrants further study to determine whether factors such as access to uterine‐sparing therapies could inform strategies to reduce hysterectomy rates in Mexico.

Serena M. Jones 1 ; Frank I. Jackson 2 ; Sarah H. Abelman 2 ; Oladunni Ogundipe 2 ; Matthew J. Blitz 2 1 New York Institute of Technology College of Osteopathic Medicine; Northwell Health, Northwell Health, NY; 2 Northwell Health, Bay Shore, NY Objective : To examine national trends in peripartum hysterectomy by delivery route among nulliparous, term, singleton, vertex (NTSV) births in the United States from 2017–2024. Study Design : This retrospective cohort study used U.S. National Vital Statistics System (NVSS) natality data from 2017–2024 to evaluate peripartum hysterectomy among NTSV births. Peripartum hysterectomy was identified using the NVSS maternal morbidity indicator. Analyses were conducted separately for NTSV vaginal and NTSV cesarean births. Annual route‐specific hysterectomy rates per 10,000 births were assessed over time using Joinpoint regression. Results : A total of 9,763,466 NTSV births were included from 2017–2024, including 7,209,720 vaginal births and 2,553,746 cesarean births. Overall hysterectomy rates were 0.75 per 10,000 among NTSV vaginal births and 4.82 per 10,000 among NTSV cesarean births. In Joinpoint analyses, the NTSV vaginal series showed a significant joinpoint in 2019, with rates increasing from 2017–2019 (APC 28.85%, 95% CI 3.85–68.41; p  = 0.017) and decreasing from 2019–2024 (APC −7.58%, 95% CI −27.05 to −1.92; p  = 0.024) (Figure 1). The NTSV cesarean series showed no significant temporal trend from 2017–2024 (APC 2.20%, 95% CI −0.56 to 5.15; p  = 0.110) (Figure 2). Conclusion : Peripartum hysterectomy among NTSV births was rare but occurred at substantially higher rates after cesarean than vaginal delivery. Vaginal hysterectomy rates changed over time, whereas cesarean rates remained stable. These findings may reflect differences in the effectiveness of uterine‐sparing strategies and postpartum hemorrhage management between delivery routes.

Paul E. Kearney 1 ; Eric Stanek 2 ; David J. Burchfield 3 ; Barbara S. Levy 4 ; Brian K. Iriye 5 ; A. Mark Fendrick 6 ; Sean D. Sullivan 7 1 Sera Prognostics, Inc., Salt Lake City, UT; 2 Carelon Research, Indianapolis, IN; 3 University of Florida, Gainesville, FL; 4 Visana Health Inc., La Jolla, CA; 5 High Risk Pregnancy Center; Hera Women's Health, Las Vegas, NV; 6 University of Michigan, Ann Arbor, MI; 7 University of Washington, Seattle, WA Objective : Preterm birth (PTB) is a leading cause of neonatal morbidity, mortality, and high neonatal healthcare costs, driven largely by neonatal intensive care unit (NICU) hospitalization. Most PTBs occur in pregnancies without apparent clinical risk factors. The IGFBP4/SHBG biomarker blood test identifies pregnancies at higher PTB risk early in gestation, enabling targeted interventions. The PRIME multicenter randomized controlled trial demonstrated reduced NICU admissions with IGFBP4/SHBG screen‐guided care. We assessed economic impact and neonatal outcomes of PRIME IGFBP4/SHBG screen‐guided care versus routine care from commercial and Medicaid payer perspectives. Study Design : We conducted a trial‐based cost‐consequence analysis alongside the PRIME trial ( n  = 4,550 after prespecified exclusions). All participants were tested; results were disclosed in the screen‐guided care arm and blinded in the routine care arm. Higher‐risk screen‐guided care participants (≥15% PTB risk) received bundled interventions (vaginal progesterone, low‐dose aspirin, and nurse‐led care management), while lower‐risk and control participants received usual care. Costs included testing, intervention, and NICU hospitalization through discharge. Outcomes were the NICU admission rate and cost per pregnancy screened. Uncertainty was assessed using bootstrap resampling and sensitivity analyses across three test prices ($550, $750, $950). Results : Screen‐guided care was associated with a 22.3% relative reduction in NICU admissions (absolute reduction 3.0% [95% CI, 1.0–4.9%]). At the base test price of $750, savings were $1,213 per pregnancy screened (95% CI, −$3,070‐$337). Across multiple test price scenarios ($550–$950), screen‐guided care consistently reduced both NICU admissions and overall costs, with the effect sustained across 89–97% of analyses. Conclusion : In a low‐risk obstetric population, screen‐guided prevention was dominant, demonstrating both improved clinical outcomes and reduced costs relative to usual care, supporting the clinical and economic value of IGFBP4/SHBG‐based screening for PTB risk in routine prenatal care.

Monica Minopoli 1 ; Sofia Ceffa 1 ; Anat Schwartz 2 ; Federica Fontanella 2 ; Veronica Giorgione 2 ; Amarnath Bhide 3 ; Basky Thilaganathan 3 1 St George's University Hospitals NHS Foundation Trust, London, United Kingdom; 2 St George's University Hospitals NHS Foundation Trust, St George's University Hospitals NHS Foundation Trust, United Kingdom; 3 St George's University Hospital, London, United Kingdom Objective : Recommendations remain inconsistent regarding routine third‐trimester ultrasound because, without a clearly defined management protocol, it has limited impact on outcomes. The rarity of severe adverse events such as stillbirth and obstetric intervention bias further weakens the evidence. This study evaluated the impact of introducing a routine 36‐week prenatal ultrasound integrated with a predefined management pathway on obstetric outcomes, focusing on timing of birth for small‐for‐gestational‐age (SGA) and large‐for‐gestational‐age (LGA) fetuses, and detection of breech presentation. Study Design : This retrospective study included 37,001 singleton term pregnancies delivered between April 2016 and October 2024. From January 2020, policy changed from targeted to universal 36‐week ultrasound with a predefined national management pathway. Primary outcomes were gestational age at birth in SGA and LGA neonates, and prenatal diagnosis of breech presentation. Secondary outcomes included neonatal intensive care unit admission, severe perineal trauma, shoulder dystocia, and stillbirth. Statistical analyses included descriptive statistics, chi‐square tests, odds ratios, linear regression, and interrupted time series analysis (ITSA). Results : The introduction of routine 36‐week ultrasound significantly increased the proportion of SGA infants delivered before 38 weeks from 18.0% to 37.5% post‐intervention ( p  = 0.02), with a concomitant reduction in NICU admissions (OR = 0.74, 95% CI: 0.66–0.82). Prenatal detection of breech presentation increased from 78% to almost 90% ( p  = 0.02) and was associated with a significant reduction in third‐ and fourth‐degree perineal tears (OR = 0.74, 95% CI: 0.65–0.84). Conclusion : The introduction of a routine prenatal ultrasound at 36 weeks embedded within a structured clinical management pathway resulted in significant changes in obstetric metrics related to improved outcomes. Overall, these findings provide real‐world evidence on how universal third‐trimester ultrasound may influence obstetric management and inform the ongoing debate on routine prenatal screening strategies.

Sofia Ceffa 1 ; Monica Minopoli 1 ; Anat Schwartz 2 ; Eleonora Biancareddu 1 ; Nikolas Sokratous 1 ; Veronica Giorgione 2 ; Amarnath Bhide 3 ; Basky Thilaganathan 3 1 St George's University Hospitals NHS Foundation Trust, London, United Kingdom; 2 St George's University Hospitals NHS Foundation Trust, St George's University Hospitals NHS Foundation Trust, United Kingdom; 3 St George's University Hospital, London, United Kingdom Objective : The role of routine third‐trimester ultrasound remains controversial, and evidence on its broader impact on obstetric practice is limited. While benefits such as improved detection of fetal growth abnormalities are recognized, less is known about unintended consequences in real‐world settings. This study aimed to assess the impact of a universal 36‐week scan on obstetric interventions and timing of birth. Study Design : his retrospective study included 37,001 singleton term pregnancies delivered between April 2016 and October 2024. From January 2020, a policy change introduced universal 36‐week ultrasound scanning alongside a standardized management pathway for SGA, LGA, and breech presentations. Primary outcomes were gestational age at birth, induction of labor, and Caesarean section rates. Analyses included descriptive statistics, chi‐square tests, odds ratios, linear regression, and interrupted time series analysis (ITSA). Results : Introduction of the routine scan was associated with a shift toward earlier gestational age at birth. Linear regression showed increasing pre‐intervention trends in induction and elective Caesarean rates, independent of the policy change. ITSA showed no immediate increase in emergency Caesarean rates overall, but a subsequent upward trend. In contrast, emergency Caesarean rates in EFW 90th centile pregnancies increased at implementation (+ 18.1% and + 10.4%), with no further rise. Emergency Caesarean for breech decreased by 13.9% ( p  = 0.01). Conclusion : The introduction of a routine prenatal ultrasound scan at 36 weeks embedded within a structured clinical management pathway, resulted in significant changes in obstetric metrics related to improved pregnancy outcome without affecting the obstetric intervention rates. Overall, these findings provide real‐world evidence on how a universal third‐trimester ultrasound may selectively influence obstetric management and inform the ongoing debate on routine prenatal screening strategies.

Shanny Kolp‐Asis 1 ; Oshrit Shtossel 2 ; Roi Yozevitch 3 ; Karin Edut 4 ; Ariel Lasry 4 ; Tamar Goiten Inbar 4 ; Avinoam Tzabari 4 ; Nissim Arbib 4 1 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv; 2 Department of Mathematics, Bar‐Ilan University, Ramat Gan, Israel; 3 Department of Computer and Software Engineering, Ariel University, Ariel, Israel; 4 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel Objective : To examine whether birthweight percentile increases with birth order, using a gestational‐age adjusted, population‐specific reference—both at the population level and through within‐mother comparisons across successive births. Study Design : This retrospective cohort study included 130,718 singleton live births from 55,057 women delivering at a high‐parity hospital (2012–2024). Birthweight percentiles were calculated using a national, sex‐specific standard. Birth order was the primary exposure; the outcome was birthweight percentile. Linear mixed‐effects models assessed population‐level associations, adjusting for maternal age, diabetes, and infant sex. Within‐mother analyses evaluated whether birthweight percentile increased across births within the same woman. Results : Later‐born infants had significantly higher birthweight percentiles than first‐borns. Each additional birth was associated with an average 3‐point increase in percentile (β ≈ 0.075 SD, p  < 0.001), consistent across model subsets. Within‐mother analyses confirmed this pattern: 55% of women with two births and ∼80% of those with ≥3 births showed increasing percentiles with birth order. Nonetheless, ∼20% of mothers had flat or negative trends, reflecting individual variation. Conclusion : Parity is a consistent predictor of higher birthweight percentile. This modest yet robust effect—observed both across and within mothers—suggests physiological adaptations such as improved placental function and reduced maternal constraint in subsequent pregnancies. Consideration of parity may enhance the interpretation of fetal growth percentiles in clinical care.

Shanny Kolp‐Asis 1 ; Tal Ayalon 2 ; Ariel Statman 2 ; Elad Miron 2 ; Karin Edut 2 ; Ariel Lasry 2 ; Oz Gavish 2 1 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv; 2 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel Objective : To identify predictors of combined vaginal–cesarean delivery (vaginal delivery of the first twin followed by cesarean delivery of the second twin) in twin gestations undergoing trial of labor. Study Design : Retrospective cohort study of twin gestations without prior cesarean delivery undergoing trial of labor at a single tertiary center (2011–2024). Analysis was restricted to pregnancies in which the first twin was delivered vaginally. The primary outcome was combined vaginal–cesarean delivery. Multivariable logistic regression models were constructed including maternal age, parity, gestational age at delivery, diabetes‐related diagnosis, induction of labor, and birthweight discordance. To avoid collinearity, first‐ and second‐twin small for gestational age (SGA) were evaluated in separate models. Results : Among eligible twin gestations, combined vaginal–cesarean delivery was uncommon. In adjusted analyses, both first‐ and second‐twin SGA were independently associated with increased odds of combined delivery. First‐twin SGA was associated with nearly a tenfold increase in risk (adjusted odds ratio [aOR], 9.97; 95% confidence interval [CI], 2.53–39.22), and second‐twin SGA with a sevenfold increase (aOR, 7.19; 95% CI, 1.83–28.27). Induction of labor showed a non‐significant trend toward increased risk, whereas maternal age, parity, gestational age, diabetes, and birthweight discordance were not significantly associated with the outcome. Conclusion : In twin gestations with successful vaginal delivery of the first twin, SGA in either twin is strongly associated with increased risk of combined vaginal–cesarean delivery. These findings suggest that fetal size, rather than labor characteristics, plays a key role in determining delivery mode of the second twin and may inform intrapartum counseling and management.

Vivienne Souter 1 ; Tomas Bosschieter 2 ; Rich Caruana 3 ; Ian Painter 1 ; Kristin Sitcov 1 ; Asma Khalil 4 1 Foundation for Health Care Quality, Foundation for Health Care Quality, Seattle, WA; 2 Stanford University, Stanford University, Palo Alto, CA; 3 Intelligible, Inc, Seattle, WA; 4 City St George's, University of London, London, United Kingdom Objective : To develop and externally validate an interpretable machine learning model to predict stillbirth using routinely collected variables from the first prenatal visit. Study Design : Retrospective cohort study including data for 212,309 singleton births at 24–43 weeks’ gestation from 22 US sites (Jan 2016‐June 2025): 211,863 were livebirths and 446 (0.21%) were stillbirths. An interpretable machine learning model (Explainable Boosting Machine) was trained to predict stillbirth using data from 155,212 births at 12 hospitals and externally validated using 57,097 births at 10 different sites. The model included 23 variables routinely available at the first prenatal visit (socio‐demographics, BMI, obstetric history, and medical history). Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value (PPV) and calibration were used to evaluate model performance. Relative feature importance was also evaluated. Odds ratios for stillbirth were calculated for each variable, adjusting for all other variables in the model. Results : Model performance metrics (95% CI) on external validation were AUROC 0.685 (0.645–0.725), sensitivity 50.4% (95% CI: 49.1–52.1), specificity 79.3% (74.3–85.7), and PPV 1.2% (95% CI:0.9–1.5) (Figure 1). Calibration was acceptable and tended to slightly overestimate risk. BMI contributed most to the model prediction with increasing risk from approximately 27 kg/m 2 . Previous stillbirth, previous preterm birth, substance use, and diabetes had the highest odds of stillbirth (Figure 2). People who were Black had increased stillbirth risk even after adjustment for medical factors and socioeconomic status. Previous cesarean birth was a statistically significant risk factor. Conclusion : Our model had modest performance for stillbirth prediction limiting its utility for population screening. However, it has promise as a tool for estimating individualized stillbirth risk as part of tailored prenatal care. Interpretable machine learning provided insights into risk factors for stillbirth including sociodemographic factors and previous cesarean birth.

Jamison Lee; Rebecca Crowe; Amartha Gore; Christina Abrams; Eliza R. McElwee; Eugene Y. Chang Medical University of South Carolina, Charleston, SC Objective : The purpose of this study was to investigate the relationship between pre‐delivery hemoglobin levels and postnatal outcomes in pregnancies complicated by sickle cell disease. Study Design : This retrospective cohort study included pregnancies complicated by sickle cell disease (SCD) between 2009–2024. Patients were stratified by pre‐delivery hemoglobin levels into two groups: ≥or <9 g/dL. The primary outcome was a composite measure of postpartum maternal morbidity consisting of postpartum hemorrhage, blood transfusion, infection, and intensive care unit (ICU) admission. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the primary outcome between groups. Data were analyzed using chi‐square test and continuous variables were assessed using t‐test as appropriate. Results : A total of 153 pregnancies among 113 patients were included in the analysis. 49.0% ( n  = 75) had pre‐delivery hemoglobin ≥9 g/dL while 51.0% ( n  = 78) had hemoglobin <9 g/dL. Hemoglobin values ranged from 5.6 g/dL to 12.7 g/dL. Cesarean section occurred more frequently in patients with hemoglobin <9 g/dL (64.1 v 37.3%, p  = 0.001). Additionally, there was an association between lower birthweight and pre‐delivery hemoglobin <9 g/dL ( p  = 0.03). The composite postpartum morbidity occurred more frequently in the hemoglobin <9 g/dL group as compared to the ≥9 g/dL group (47.4% vs. 29.3%, p  = 0.02). Of individual morbidity components, postpartum transfusion rates were significantly higher in the <9 g/dL group (47.4% vs 17.3%, p  = 0.001). When compared to the reference group (hemoglobin ≥9 g/dL), the odds of composite postpartum morbidity were 2.17 with a 95% CI 1.11–4.23. This association did not reach statistical significance when adjusted for mode of delivery and pregnancy related hypertension (aOR 1.45, 95% CI 0.69 – 3.04). Conclusion : In pregnancies affected by SCD, lower pre‐delivery hemoglobin was associated with increased rates of postpartum morbidity. These findings emphasize the benefit of optimizing maternal hemoglobin prior to delivery.

Jamison Lee; Rebecca Crowe; Amartha Gore; Eliza R. McElwee; Christina Abrams; Eugene Y. Chang Medical University of South Carolina, Charleston, SC Objective : This study aimed to evaluate the association between first trimester hemoglobin levels and maternal antenatal complications in pregnancies complicated by sickle cell disease (SCD). Study Design : We conducted a retrospective cohort study of pregnancies affected by SCD from 2009–2024. Patients were stratified by first trimester hemoglobin ≥9 or <9 g/dL. The primary outcome was a composite of maternal morbidity including acute pain crisis, acute chest syndrome, venous thromboembolism, antepartum infection, and antepartum transfusion. Categorical variables were analyzed using Chi‐squared tests and continuous variables were assessed using t‐test as appropriate. Logistic regression was utilized to generate odds ratio of composite maternal morbidity by degree of anemia severity. Results : A total of 113 patients with 153 pregnancies were included in the study. 51.3% ( n  = 78) of patients with SCD had first trimester hemoglobin levels above and 48.7% ( n  = 74) below 9.0 g/dL. First trimester hemoglobin <9 g/dL was associated with higher composite antepartum morbidity compared to those with hemoglobin ≥9 g/dL (90.5 v 65.4%, p  = 0.001). Patients with hemoglobin <9 were more likely to be admitted for pain crisis (63.5 v 35.9%, p  = 0.001) and require antepartum transfusion (56.8 v 23.1%, p  = 0.001). When compared to a reference group of hemoglobin ≥9 g/dL, odds of maternal morbidity are greatest when hemoglobin is 7.0–7.9 g/dL (OR 19.36, 95% CI 2.51–148.7). Conclusion : Lower first trimester hemoglobin is associated with increased maternal morbidity in pregnancies complicated by sickle cell disease. This association helps to identify patients at risk for antenatal maternal complications.

Emily H. Stetler 1 ; Cassandra Heiselman 2 ; Omar Abuzeid 3 ; Tiffany Yang 4 ; David J. Garry 5 ; Diana Garretto 6 ; Kimberly Herrera 7 1 Lenox Hill Hospital ‐ Northwell, New York, NY; 2 Stony Brook University, Cleveland Clinic, OH; 3 Franciscan physician network, Orland Park, IL; 4 Stony Brook University, Stony Brook, NY; 5 Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; 6 Catholic Health, Buffalo, NY; 7 Stony Brook University Hospital, Stony Brook, NY Objective : Cervical cerclage is a treatment for prevention of preterm birth in patients with known cervical insufficiency and in certain cases of short cervix. Use of one versus two sutures placed at the time of history‐ or ultrasound‐indicated cerclages requires further investigation. We compared cervical lengths after single versus double cerclage placement. Study Design : This was an IRB‐approved, randomized controlled trial at a single institution between 2021 and 2025. Inclusion criteria were patients ≥18 years old with a singleton pregnancy with a history‐ or ultrasound‐indicated cerclage. Exclusion criteria included fetuses with known aneuploidies or anomalies, fetal demise, suspected chorioamnionitis, rupture of membranes, multifetal gestation, and planned surgical technique besides McDonald. Patients were randomized to a single or double suture to be placed as a McDonald cerclage. Patient characteristics were collected. Groups were compared using two‐way mixed ANOVA, Chi‐square, Fisher's exact, Mann‐Whitney U, and independent t‐tests with statistical significance defined as p  < 0.05. Results : There were 85 patients meeting entry criteria with 43 patients (50.6%) randomized to one suture and 42 patients (49.4%) randomized to two sutures. Groups were similar for age, parity, previous preterm delivery, history of cervical/uterine surgery, gestational age (GA) at time of cerclage, and indication for cerclage ( p  > 0.05). There was no difference in cervical lengths between one and two sutures pre‐cerclage ( p  = 0.95) or post‐cerclage ( p  = 0.47) [Figure 1]. Paired analysis found an increase in cervical length after cerclage placement for both groups ( p  < 0.001) [Figure 2]. The mean difference for the single suture group was + 5.81 mm ( p  = 0.003), and the mean difference for the double suture group was + 5.77 mm ( p  = 0.002). The change over time did not differ between single and double suture groups ( p  = 0.98). Conclusion : The placement of cerclage, regardless of number of sutures, lengthens the cervix on post‐procedure ultrasound; however, the change in cervical lengths was similar between the two groups.

Emily H. Stetler 1 ; Cassandra Heiselman 2 ; Omar Abuzeid 3 ; Bijal Parikh 4 ; Tiffany Yang 5 ; Zenobia Gonsalves 5 ; Rachel Lee 5 ; Lama R. Noureddine 6 ; Mia A. Heiligenstein 7 ; David J. Garry 8 ; James Bernasko 5 ; Cecilia Avila 5 ; Jennifer H. Choi 5 ; Ayesha Hussain 5 ; Diana Garretto 9 ; Kimberly Herrera 10 1 Lenox Hill Hospital ‐ Northwell, New York, NY; 2 Stony Brook University, Cleveland Clinic, OH; 3 Franciscan physician network, Orland Park, IL; 4 St. Peters University Hospital, New Brunswick, NJ; 5 Stony Brook University, Stony Brook, NY; 6 Rutgers health, Newark, NJ; 7 Mount Sinai Health System, New York, NY; 8 Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; 9 Catholic Health, Buffalo, NY; 10 Stony Brook University Hospital, Stony Brook, NY Objective : Cervical cerclage is a treatment for prevention of preterm birth in patients with known cervical insufficiency. Use of one versus two sutures placed at the time of history‐ or ultrasound‐indicated cerclages needs further investigation. We examined rates of preterm delivery comparing single versus double suture placement at time of cerclage. Study Design : This was an IRB‐approved, randomized controlled trial at a single institution between 2021 and 2025. Inclusion criteria were patients ≥18 years old with a singleton pregnancy with a history‐ or ultrasound‐indicated cerclage indication. Exclusion criteria included fetuses with known aneuploidies or anomalies, fetal demise, suspected chorioamnionitis, rupture of membranes, multifetal gestation, and planned surgical technique besides McDonald. Patients were randomized to a single or double suture to be placed as a McDonald cerclage. Patient characteristics and perinatal outcomes were collected. Groups were compared using Chi‐square, Fisher's exact, Mann‐Whitney U, and independent t‐tests with statistical significance defined as p  < 0.05. Results : There were 85 patients meeting entry criteria with 43 patients (50.6%) randomized to single suture, and 42 patients (49.4%) randomized to double suture placement. Groups were similar for age, parity, prior cervical/uterine surgery, previous preterm delivery, cervical length prior to placement, gestational age (GA) at time of cerclage, and indication for cerclage ( p  > 0.05). Cerclage complication rates were low and similar between groups (4.7% vs 4.8%, p  = 0.98). The groups were similar for the incidence of preterm birth <37 weeks (single 37.5% vs double 29.7%; p  = 0.47) and preterm birth <34 weeks (single 11.9% vs double 14.6%, p  = 0.71) [Figure 1]. There were no differences in perinatal outcomes, including live birth rate, gestational age at delivery, and birth weight [Table 1]. Conclusion : The incidence of preterm birth did not differ when comparing one versus two sutures; however, there was a clinical trend in reduction in preterm delivery with placement of double suture cerclage.

Emily H. Stetler 1 ; Cassandra Heiselman 2 ; Omar Abuzeid 3 ; Tiffany Yang 4 ; Zenobia Gonsalves 4 ; Rachel Lee 4 ; David J. Garry 5 ; Kimberly Herrera 6 ; Diana Garretto 7 1 Lenox Hill Hospital ‐ Northwell, New York, NY; 2 Stony Brook University, Cleveland Clinic, OH; 3 Franciscan physician network, Orland Park, IL; 4 Stony Brook University, Stony Brook, NY; 5 Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; 6 Stony Brook University Hospital, Stony Brook, NY; 7 Catholic Health, Buffalo, NY Objective : Funneling is a risk factor for preterm delivery. Cerclage is a treatment modality for the prevention of preterm birth in patients with cervical insufficiency or short cervix. The aim of our study was to assess the effect of the placement of one versus two sutures on the presence of funneling post cerclage. Study Design : This was an IRB‐approved, randomized controlled trial at a single institution between 2021–2025. Inclusion criteria were pregnant patients ≥18 years old with a history or ultrasound cerclage indication. Exclusion criteria included aneuploidy or anomalies, fetal demise, suspected chorioamnionitis, multifetal gestations, and rupture of membranes. Patients were randomized to single or double suture during McDonald cerclage placement. Patient characteristics and ultrasound data were collected. Groups were compared using two‐way mixed ANOVA, Chi‐square, Fisher's exact, Mann‐Whitney U, and independent t‐tests with statistical significance defined as p  < 0.05. Results : 85 patients met entry criteria with 43 patients (50.6%) randomized to one suture, and 42 patients (49.4%) randomized to two sutures. Characteristics were similar across groups, including age, parity, previous preterm delivery, gestational age (GA) at time of cerclage and indication for cerclage ( p  > 0.05). Funneling prior to cerclage placement was similar across groups (18.6% vs 21.4%; p  = 0.75). There was no difference in the GA when funneling was noted post‐cerclage (23.1 ± 11.5wks vs 23.3 ± 11.3wks, p  = 0.95). During paired analysis, no difference in funneling between the one‐ versus two‐suture groups was found ( p  = .59), and the change in funneling over time did not differ by suture number ( p  = .18). There was a non‐significant trend toward increased funneling after cerclage observed in the one‐suture group (18.6% vs 32.6%; p  = .06) while the two‐cerclage group saw no change in the rate of funneling (21.4% vs 21.4%). [Figure 1]. Conclusion : When two sutures were placed at time of cerclage, a clinically lower rate of funneling was seen on post‐cerclage ultrasound. This trend requires a larger powered sample to clarify the association.

Sarit Helman 1 ; Maayan Y. Bas‐Lando 2 ; Ofri Oren 2 ; Sorina Grisaru‐Granovsky 1 ; Orit Barenholz 2 1 Shaare Zedek Medical Center, Jerusalem, Israel; 2 SZMC, Jerusalem, Israel Objective : Investigate the relationship between continuous glucose monitoring (CGM) derived glucose metrics, in each trimester, and the pregnancy outcomes in women with type 1 diabetes mellitus (T1DM). Study Design : A retrospective cohort study (2020–2025) compared CGM metrics between women with T1DM who experienced pregnancy complications and those with uncomplicated deliveries. The primary outcome was large for gestational age (LGA); the secondary outcome was a composite of pregnancy complications. Associations with outcomes were evaluated using binary and multivariable logistic regression, including stepwise models (95% CI). ROC curves were constructed for metrics significantly associated with the primary outcome. Results : CGM data were analyzed from 88 women; 32 (36.4%) delivered LGA infants and 56 (63.6%) did not. Women with LGA outcomes had higher mean glucose levels and lower time in range (TIR) across all three trimesters. Higher glucose standard deviation (SD) and greater time above range (TAR) during the second trimester were also significantly associated with LGA. TIR across all trimesters was associated with the secondary outcome. Second‐trimester TIR was the strongest predictor of LGA, with each 5% increase in TIR associated with a 35% reduction in risk (OR 0.65, p  < 0.05). A TIR threshold of ≥60% optimally discriminated LGA risk, with sensitivity 0.75 and specificity 0.63. Conclusion : Higher CGM TIR during pregnancy was associated with lower LGA risk, with second‐trimester TIR showing the strongest predictive value. These findings suggest that the second trimester may be a window of opportunity for interventions to improve glycemic control and potentially reduce LGA risk.

Katharina Schley 1 ; Hannah Collacott 2 ; Yasmijn Slaghekke 3 ; Josh Coulter 4 ; Chelsea S. Lutz 4 ; Michelle Vichnin 4 ; Sarah J. Pugh 5 ; Jessica Atwell 4 ; Yasmeen Agosti 4 ; Melissa Ross 6 1 Pfizer Pharma GmbH, Berlin, Germany; 2 Thermo Fisher Scientific, Wilmington, NC; 3 ThermoFisher Scientific, London, United Kingdom; 4 Pfizer Inc., New York, NY; 5 Pfizer Inc., Collegeville, PA; 6 ThermoFisher Scientific, Wilmington, NC Objective : There is a significant burden of invasive Group B Streptococcus (GBS) infections in infancy, despite the use of intrapartum antibiotic prophylaxis (IAP) in some settings. The World Health Organization has identified development of maternal GBS vaccines (Vx) as a priority. We elicited US prenatal healthcare provider (HCP) knowledge and perspectives on GBS burden and Vx use. Study Design : Sixty‐minute online semi‐structured qualitative interviews were conducted with 20 prenatal HCPs who directly manage pregnant patients’ care in the United States. Interview transcripts were coded using deductive and inductive content analysis. Results : Sample characteristics are reported in Table 1. Concerns relating to GBS in pregnancy varied. Most HCPs with moderate‐high concern ( n  = 13) cited severe neonatal outcomes ( n  = 12); HCPs reporting low concern ( n  = 7) cited IAP effectiveness ( n  = 4) or infant care being beyond their remit ( n  = 3). Knowledge of early (EOD) vs. late (LOD) onset disease was limited: 16 participants reported some familiarity, but none demonstrated detailed understanding of the definitions or differences. Participants were receptive to maternal GBS Vx approved only for infant outcomes ( n  = 18); all reported moderate‐strong likelihood of recommending such a Vx, and a majority ( n  = 13) expected their patients to be receptive. Perceived GBS Vx benefits included the avoidance of process burdens of GBS screening and/or IAP ( n  = 9) and missed GBS cases due to early or rapid labor ( n  = 7) and reducing antibiotic use and resistance ( n  = 7). Protection against LOD was not spontaneously raised as a Vx benefit. Perceived patient GBS‐Vx hesitancy ( n  = 7) stemmed from general Vx hesitancy and Vx fatigue ( n  = 5) and the efficacy of IAP ( n  = 3). Conclusion : Gaps in prenatal HCPs’ knowledge regarding GBS disease in infants, particularly LOD, may impede their valuation of future maternal GBS Vx. Increasing prenatal HCP knowledge around infant GBS infections may improve patient uptake. Access to a maternal Vx may promote a sense of agency among prenatal HCPs in terms of their role in LOD prevention.

Madison Calvert 1 ; Monjur Rahman 2 ; Katelyn J. Rittenhouse 3 ; Teeranan Popkaprakarn 4 ; Yuri Sebastião 4 ; Margaret P. Kasaro 5 ; Bellington Vwalika 6 ; Christina Perez 4 ; Jesmin Pervin 2 ; Kristina De Paris 7 ; Jeffrey Stringer 4 ; Anisur Rahman 2 1 University of North Carolina School of Medicine, Chapel Hill, NC; 2 International Centre for Diarrhoeal Disease Research, Matlab Health Research Centre, Matlab, Bangladesh; 3 University of North Carolina, Durham, NC; 4 Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; 5 UNC Global Projects‐Zambia, LLC, Lusaka, Zambia; 6 Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia; 7 Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC Objective : To identify maternal metabolomic profiles associated with fetal growth restriction (FGR) and small‐for‐gestational age (SGA) births and to evaluate how these phenotypes relate to adverse pregnancy outcomes across diverse global populations. Study Design : We analyzed data from a combined cohort of 5434 singleton pregnancies from Zambia ( n  = 2,059) and Bangladesh ( n  = 3,375). FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) <10 th percentile after 24 weeks’ gestation; severe FGR was defined as EFW <3 rd percentile. We compared the risk of SGA and stillbirth among pregnancies with and without FGR. Maternal plasma samples collected between 28 and 34 weeks underwent untargeted metabolomic profiling with pathway enrichment analyses to identify metabolites associated with FGR and SGA. Results : Overall, 21.7% of pregnancies met criteria for FGR (Bangladesh: 32%; Zambia: 5%) and 5.4% (291) for severe FGR. FGR was strongly associated with SGA (49% vs 18% risk; risk difference, RD: 31%; 95% CI 27–34), with greater association among severe FGR (60% vs 18%; RD: 42%; 95% CI 36–48). FGR was also associated with increased stillbirth risk (1.4% vs 0.7%), highest among severe FGR (3.1%). Metabolomic analyses identified both shared and distinct biological pathways underlying impaired fetal growth. Lipid and steroid hormone metabolism were primarily associated with SGA, while FGR was linked to nitrogen metabolism, arginine biosynthesis, and amino acid metabolism. Dihydrothymine, involved in pyrimidine metabolism, emerged as a common metabolite associated with both FGR and SGA, however the metabolite differed in enrichment across phenotypes. Conclusion : Maternal metabolic profiles revealed distinct and overlapping biological pathways associated with FGR and SGA across diverse populations. These findings provide insight into the heterogeneity of impaired fetal growth and may inform future approaches to risk stratification and early identification of pregnancies at highest risk for adverse outcomes.

Madison Calvert 1 ; Austin Oberlin 2 ; Imanga Ikabongo 3 ; Katelyn J. Rittenhouse 4 ; M. Bridget Spelke 5 ; Margaret P. Kasaro 6 ; Bellington Vwalika 7 ; Yuri Sebastião 8 ; Jeffrey Stringer 8 ; Elizabeth M. Stringer 5 1 University of North Carolina School of Medicine, Chapel Hill, NC; 2 Yale University, New Haven, CT; 3 University of Zambia, Lusaka, Zambia; 4 University of North Carolina, Durham, NC; 5 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC; 6 UNC Global Projects‐Zambia, LLC, Lusaka, Zambia; 7 Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia; 8 Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC Objective : Fetal growth restriction (FGR) as defined by fetal weight (EFW) <10 th percentile is known to include many fetuses that have constitutionally small growth. In low resource settings, a more discriminating definition of FGR is needed, to better predict those pregnancies most at risk. Our aim was to evaluate whether alternative EFW percentile thresholds improve the ability of ultrasound‐defined FGR to predict adverse perinatal outcomes. Study Design : We combined participants from one observational cohort and two randomized studies conducted in Lusaka, Zambia between 2015–2022. Singleton pregnancies without fetal anomalies were included. All had at least one growth US after 20 weeks, most frequently between 32–34 weeks. Our outcomes were perinatal mortality (stillbirth or neonatal death within 28 days), and small for gestational age (SGA; using WHO growth curve). EFW was calculated using Hadlock‐4, and the definition of FGR was adjusted from <15 th to <1 st percentile. For each threshold, we estimated area under the ROC curve and calculated sensitivity, specificity, positive and negative predictive values. Results : Among 3239 singletons included, perinatal mortality occurred in 180 (5.6%) and 657 (20.3%) were born SGA. As the FGR threshold is increased and the test positivity rate increases, the sensitivity increases, and specificity decreases for both perinatal mortality and SGA (Table 1 and 2). However, discrimination for perinatal mortality remains low across all thresholds (AUC range: 0.53 to 0.56; Table 1). In contrast, prediction of SGA improved with higher EFW percentile cut offs, with AUC rising to 0.66 at EFW <15 percentile. Conclusion : In this population, a higher EFW percentile threshold to define FGR did not meaningfully improve discrimination of perinatal mortality, while substantially increasing the proportion of pregnancies screening positive. Regardless of the EFW threshold used, FGR is not very sensitive for predicting perinatal mortality. Further study into additional ultrasound markers or maternal serum biomarkers should be explored to supplement our approach reliant on EFW alone.

Youzhen Zhang; Nana Huang; Jing Yang; Yangyu Zhao Peking University Third Hospital, Beijing, China (People's Republic) Objective : Fetal growth restriction (FGR) is associated with neonatal brain injury and neurodevelopmental impairment. The placenta‐brain axis has been conceptually proposed, yet no molecular mediator linking placental dysfunction to fetal neurological injury has been identified. We aimed to delineate the placental cellular landscape in FGR, identify placenta‐derived effectors of fetal brain injury, and translate findings into a prediction and intervention framework. Study Design : A prospective FGR cohort with matched controls was established, integrating clinical phenotyping, biospecimen collection, and 2–3 year neurodevelopmental follow‐up via Ages and Stages Questionnaire‐3 (ASQ‐3). Single‐cell RNA sequencing of placental tissue identified candidate effectors, whose cord blood levels were correlated with placental pathology and neurodevelopmental outcomes and incorporated into machine learning (ML) models. To establish causality, a rat FGR model tested whether the identified effector induces fetal brain injury and whether its antagonism rescues neuropathology and adult offspring behavior. Results : Single‐cell profiling identified fibroblast‐to‐myofibroblast transition (FMT) as the dominant stromal remodeling in FGR placentas, with activated myofibroblasts as a primary source of macrophage migration inhibitory factor (MIF). Cord blood MIF correlated positively with placental fibrosis and negatively with neurodevelopmental scores. ML models incorporating cord blood MIF outperformed clinical‐only models for predicting adverse neurodevelopment. In the rat model, MIF induced M1 microglial polarization and neuroinflammation in fetal brain, while MIF antagonism rescued neonatal brain injury and normalized adult offspring behavioral outcomes. Conclusion : This study establishes the first molecular link in the placenta‐brain axis: FMT‐derived MIF drives fetal neuroinflammation via microglial activation. Cord blood MIF serves as a delivery‐accessible biomarker for neurodevelopmental risk stratification, and MIF blockade represents a candidate therapeutic strategy for FGR‐associated brain injury.

Agnese Caneschi 1 ; Marina Tartarone 2 ; Lucrezia Viscioni 3 ; Chiara Lubrano 1 ; Ottavio Cassardo 1 ; Michele Orsi 1 ; Valentina Romagnoli 2 ; Federica Locati 4 ; Elisa Sabattini 3 ; Martina Zoppetti 2 ; Irene Cetin 4 ; Francesca Parisi 4 On behalf of Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italia 1 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; 2 Università degli Studi di Milano, Milano, Italy; 3 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 4 S.C Ostetricia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy Objective : To evaluate the association between maternal first‐trimester steroid hormone profiles and spontaneous miscarriage. Study Design : This prospective longitudinal cohort study included women with spontaneous singleton pregnancies recruited between 5 + 0 and 7 + 6 weeks’ gestation at a tertiary obstetric centre. Gestational age was based on last menstrual period, corrected for cycle length and confirmed by ultrasound. Miscarriage was defined according to ISUOG 2013 criteria. Maternal steroid hormones were quantified and analysed individually and using principal component analysis (PCA). Uterine artery pulsatility index (UtA‐PI) and maternal hemodynamics (USCOM) were evaluated at 11–13 weeks. PCA identified three cardiovascular phenotypes. Multivariable logistic regression assessed associations with miscarriage. Results : Seventy‐nine women were enrolled, of whom 14 experienced spontaneous miscarriage. Maternal age and early gestational weight gain were independently associated with increased risk (aOR 1.71, 95% CI 1.04–2.81 and aOR 3.94, 95% CI 1.12–13.82). Higher androstenedione (aOR 0.02, 95% CI 0.01–0.99) and 17‐hydroxyprogesterone (aOR 0.08, 95% CI 0.01–0.99) were associated with reduced risk. PCA identified an androgenic/luteal profile, characterized by high 17‐hydroxyprogesterone, testosterone and androstenedione, representing the second most prevalent pattern and independently associated with lower miscarriage risk (aOR 0.03, 95% CI 0.01–0.91). This profile was also associated with a cardiovascular phenotype characterized by higher UtA‐PI and lower cardiac output at 12 weeks (β = 0.37, 95% CI 0.08–0.67). Conclusion : Maternal steroid hormone patterns are associated with miscarriage risk and an androgenic/luteal profile appears protective. This profile is linked to increased uterine vascular resistance, suggesting interplay between endocrine regulation and early uteroplacental vascular development and possibly reflecting a more favourable angiogenic balance. Thus, multidimensional hormonal profiling may represent a promising early biomarker of pregnancy viability.

Noa Zohar 1 ; Liat Mor 2 ; Eliel Kedar Sade 2 ; Eran Weiner 2 ; Lior Kashani Ligumsky 2 1 Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; 2 Edith Wolfson Medical Center, Holon, Israel Objective : To evaluate the diagnostic performance of digital whole‐slide imaging compared with conventional light microscopy for detecting placental lesions, using microscopy as the reference standard. Study Design : In this retrospective study, 118 placentas were independently evaluated by a single blinded observer using both conventional microscopy and digital whole‐slide imaging. Placental lesions were classified according to the Amsterdam Placental Workshop Group Consensus Criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) were calculated for each lesion. Results : Digital pathology demonstrated excellent performance for inflammatory lesions. Maternal inflammatory response and acute meconium were identified with 100% sensitivity and specificity (AUC 1.00). Fetal inflammatory response also showed high accuracy (sensitivity 93.8%, specificity 100%, AUC 0.969), as did villitis of unknown etiology (AUC 0.884). In contrast, performance for vascular lesions was lower. For maternal vascular malperfusion (MVM), sensitivity was high (87.0%) but specificity limited (55.1%), reflecting overdiagnosis (AUC 0.710). Fetal vascular malperfusion (FVM) showed low sensitivity (37.5%) despite high specificity (96.1%) (AUC 0.668). Cord abnormalities and prolonged meconium showed good performance (AUC 0.892 and 0.869). NPVs were consistently high. Conclusion : Digital placental pathology demonstrates high accuracy for inflammatory and gross lesions, with lesion‐dependent limitations for vascular pathology. Overdiagnosis of MVM may be clinically acceptable, as MVM is recurrent and potentially preventable, and preventive strategies such as low‐dose aspirin are safe and effective. A sensitivity‐oriented approach may support identification of patients who could benefit from prevention, while underdetection of FVM is likely less consequential given its low recurrence risk and lack of preventive interventions.

Liat Mor; Shir Lev; Alona Boukin; Noa Ben‐Shoshan; Dana Cohen; Eran Weiner; Giulia Barda Edith Wolfson Medical Center, Holon, Israel Objective : To evaluate the effect of reflexology administered during induction of labor with an extra‐amniotic balloon on maternal anxiety, pain, satisfaction, and obstetric outcomes. Study Design : In this randomized controlled study, 84 pregnant patients undergoing labor induction with an extra‐amniotic balloon were assigned to reflexology plus standard care ( n  = 42) or standard care alone ( n  = 42). Maternal anxiety was assessed using the State‐Trait Anxiety Inventory (STAI) and pain using the Visual Analog Scale (VAS) at baseline and during induction. Patient satisfaction was evaluated after induction initiation. Baseline characteristics and delivery outcomes were compared. Continuous variables were analyzed using t‐test or nonparametric equivalents and categorical variables using chi‐square or Fisher's exact test. Results : Baseline STAI scores were similar between groups (48 vs. 46.5, p  = 0.537). Final STAI scores were significantly lower in the reflexology group (30 vs. 48, p  < 0.001), with greater anxiety reduction (ΔSTAI 14.2 ± 12.7 vs. −1.5 ± 9.9, p  < 0.001). Pain scores were also lower (VAS 3 vs. 6, p  < 0.001). Satisfaction was higher in the reflexology group (9 vs. 5, p  < 0.001), as was likelihood of recommending the intervention (10 vs. 4, p  < 0.001). No differences were observed in baseline characteristics or obstetric outcomes, including gestational age at delivery, induction duration, time to delivery, vaginal delivery within 24 hours, mode of delivery, postpartum hemorrhage, intrapartum fever, or neonatal birthweight. Conclusion : Reflexology administered during induction of labor with an extra‐amniotic balloon is associated with significant reductions in maternal anxiety and pain and improved patient satisfaction, without affecting obstetric and delivery outcomes. These findings support reflexology as a safe and effective complementary intervention to improve maternal experience during labor induction.

Liat Mor 1 ; Eliel Kedar Sade 1 ; Noa Zohar 2 ; Eran Weiner 1 ; Lior Kashani Ligumsky 1 1 Edith Wolfson Medical Center, Holon, Israel; 2 Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel Objective : To compare clinical, neonatal, and placental characteristics among nulliparous women with preeclampsia (PET), multiparous women with primary PET, and women with recurrent PET. Study Design : This retrospective cohort study included 416 pregnancies complicated by PET: nulliparous ( n  = 246), multiparous without prior PET ( n  = 114), and recurrent PET ( n  = 56). Maternal characteristics, delivery outcomes, neonatal outcomes, and placental histopathology were compared between groups. Placental lesions were classified according to the Amsterdam Placental Workshop Group Consensus Criteria. Results : Multiparous and recurrent PET groups were older than nulliparous patients (34.1 ± 5.5 and 33.5 ± 5.8 vs 30.3 ± 6.5 years, p  < 0.001). Chronic hypertension was significantly more prevalent in recurrent PET (30.3% vs 11.8% and 10.5%, p  < 0.001). Despite these baseline differences, gestational age at delivery, cesarean delivery rate, birthweight, fetal growth restriction (FGR), NICU admission, and composite neonatal outcomes were similar across groups. Placental findings demonstrated consistently high rates of maternal vascular malperfusion (MVM) across all groups (69.9%, 74.6%, and 78.5%, p  = 0.296), with no significant differences in fetal vascular malperfusion. Inflammatory placental lesions were infrequent and did not demonstrate a consistent pattern across groups. Other placental findings, including villitis of unknown etiology and cord abnormalities, were comparable between groups. Conclusion : Preeclampsia demonstrates a similar clinical and placental phenotype across nulliparous, multiparous, and recurrent cases, characterized predominantly by maternal vascular malperfusion. Despite a higher prevalence of baseline risk factors in recurrent PET, maternal, neonatal, and placental outcomes were comparable, supporting a shared disease pathway once PET develops. These findings highlight the central role of placental vascular pathology in PET, irrespective of parity or recurrence status.

S. Yogeshkumar 1 ; Rupsa C. Boelig 2 ; Mrutyunjaya B. Bellad 1 ; Manjunath S. Somannavar 3 ; Sudhir Bhandari 4 ; Sudhir Mehta 5 ; Seema Mehta 5 ; Dharmesh Sharma 5 ; Umesh Charantimath 1 ; Ashalata A. Mallapur 6 ; Umesh Ramadurg 6 ; Radha Sangavi 7 ; Praveen S. Patil 7 ; Subarana Roy 8 ; Phaniraj Vastrad 8 ; Benjamin E. Leiby 9 ; Rebecca Hartman 9 ; Simal Thind 9 ; Richard Derman 9 On behalf of RAPIDIRON Trial Group 1 Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (KAHER), Belagavi, India; 2 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 3 KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India; 4 Sawai Man Singh Medical College, Belagavi, India; 5 Sawai Man Singh Medical College, Jaipur, India; 6 S. Nijalingappa Medical College and H.S.K. Hospital & Research Centre, Bagalkot, India; 7 Raichur Institute of Medical Sciences (RIMS), Raichur, India; 8 Model Rural Health Research Unit, Sirwar, India; 9 Thomas Jefferson University, Philadelphia, PA Objective : Oral iron is first line therapy for iron deficiency anemia in pregnancy, however adherence to oral iron can vary greatly. We aimed to evaluate the impact of oral iron adherence on response to therapy and pregnancy outcomes. Study Design : This is a secondary analysis of a multi‐center randomized controlled trial in India in which participants with moderate iron deficiency anemia were randomized to IV iron or oral iron 60 mg BID at 14–17 weeks gestation to continue through pregnancy. This secondary analysis includes only those randomized to oral iron. Adherence to oral iron and folic acid supplements was assessed with adherence defined as 80% adherent to the supplements across the study period and not missing more than one study visit. Responses to the question about how often the participant consumed the tables were re‐coded as follows: all of the days = 1, most of the days = 0.67, few days = 0.33, and not consumed = 0. The responses across all four study visits were then averaged to determine adherence. Associations between adherence status and pregnancy outcomes were evaluated using site adjusted Cochran–Mantel–Haenszel relative risks with 95% confidence intervals for categorical outcomes. Two‐sided alpha 0.05 considered significant. Results : 1095 participants were classified as adherent to oral iron and 312 as non‐adherent. Adherence varied by site, but not by maternal age. Across all analyses (oral iron only, and combined oral and folic acid adherence), good adherence to supplementation was associated with significantly lower rates of unscheduled maternal hospitalization (RR range: 0.70–0.71), need for intravenous iron (RR range: 0.63–0.64), and notably reduced rate of stillbirths (RR range: 0.33–0.37) (see Table 1, 2). Conclusion : Adherence to iron and folic acid supplementation in pregnancies with moderate iron deficiency anemia has a significant impact on maternal health, therapy response, and pregnancy outcomes. National guidelines for implementation of nutritional supplementation should account for adherence assessment to identify those likely to require alternative therapy.

Maisa Manasar‐Dyrbuś 1 ; Natalia Lekston 2 ; Sebastian Żabierek 3 ; Marcin Domżalski 3 ; Rafał Stojko 1 ; Jakub Staniczek 1 1 Department of Gynecology, Obstetrics and Gynecological Oncology Medical University of Silesia, Katowice, Poland; 2 Medical University of Silesia, Katowice, Poland; 3 Department of Orthopedics, Medical University of Łódź, Łódź, Poland Objective : Breech presentation increases the risk of developmental dysplasia of the hip (DDH). Elective cesarean section (CS) reduces perinatal complications but does not eliminate DDH risk associated with abnormal fetal positioning. Successful external cephalic version (ECV) converts the fetus to cephalic position before delivery, potentially lowering DDH risk. The aim of this study was to compare DDH incidence in newborns after successful ECV versus elective CS due to breech presentation. Study Design : Retrospective study of 100 newborns: 42 after successful ECV and 58 after elective CS. Hip ultrasonography within the first 3 months of life was performed using the Graf method. Follow‐up was conducted at ≥6 months when indicated. Statistical analysis used the chi‐square test or Fisher's exact test, with relative risk and 95% confidence intervals. Results : At ≤3 months of age, normal hip ultrasound findings (Graf Ia/Ib) were observed in 85.7% of newborns after successful ECV and in 65.5% after elective CS. Suspicious findings (Graf IIa) were more frequent in the CS group (29.3% vs 14.3%), and hip dysplasia (≥IIc) was detected only in the CS group (5.2% vs 0%). The difference showed a statistical trend but did not reach significance (chi‐square test, p  = 0.052). At ≥6 months of follow‐up (in infants with prior Graf IIa findings), normalization occurred in 83.3% of the ECV group and 58.8% of the CS group, while progression to Graf IIb was observed in 16.7% and 41.2%, respectively. This difference was not statistically significant (Fisher's exact test, p  = 0.369). In the combined analysis (≤3 months + ≥6 months), abnormal hip ultrasound findings were significantly more frequent in the CS group (17.2%) compared to the ECV group (2.4%). Fisher's exact test confirmed a statistically significant difference ( p  = 0.020), indicating a lower risk of hip abnormalities after successful ECV. Conclusion : Results suggest that successful ECV may reduce the risk of DDH of the hip compared with planned cesarean delivery due to breech presentation.

Sivan Partush Chocron 1 ; Tamar Wainstock 2 ; Eyal Sheiner 3 ; Gil Gutvirtz 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 : Meconium‐stained amniotic fluid (MSAF) is a common obstetric finding during labor and may be associated with non‐reassuring fetal status. While perinatal complications of MSAF have been described in literature, the long‐term implication of MSAF for the offspring is less investigated. We aimed to evaluate the long‐term impact of MSAF exposure on offspring morbidity in children born via cesarean delivery (CD) for labor dystocia alone, without signs of fetal distress. Study Design : A population‐based retrospective cohort study was conducted including singleton born via CD due to labor dystocia, and followed until 18 years of age. Long‐term morbidity was assessed comparing children who were exposed to MSAF and unexposed children, using a large integrated community and hospital medical database. Kaplan‐Meier survival curves were used for cumulative offspring morbidity over time and multivariable Cox models were constructed to adjust for potential confounders. Results : A total of 4628 singleton CD due to labor dystocia were included, of whom 1191 (25.7%) children were exposed to MSAF. We found no association between MSAF exposure and long‐term offspring morbidity across any of the examined categories: cardiovascular, respiratory and neurologic (Table). Kaplan–Meier survival curves demonstrated comparable cumulative incidence (Figure). Multivariable regression models, adjusting for gestational age, diabetes mellitus and hypertensive disorders of pregnancy, confirmed that MSAF exposure did not elevate the risk for any of the offspring long‐term morbidities examined in this study. Conclusion : Exposure to MSAF was not independently associated with long‐term offspring morbidity across any examined domain. These findings suggest that fetal meconium exposure alone, in the absence of fetal distress, does not seem to increase the risk of long‐term morbidity.

Sivan Partush Chocron; Tamar Eshkoli Soroka University Medical Center, Beersheba, Israel Objective : Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor affecting young women and is typically treated with pancreaticoduodenectomy (Whipple procedure). While surgical outcomes are generally favorable, the procedure results in significant long‐term metabolic and nutritional alterations. Pregnancy following Whipple procedure is exceedingly rare, and evidence regarding optimal obstetric management remains limited. Study Design : We report a woman in her early 20s who underwent pancreaticoduodenectomy for SPN, complicated by postoperative pancreatitis requiring reoperation and long‐term pancreatic enzyme replacement therapy. Five years later, she conceived via intrauterine insemination and was followed in a multidisciplinary high‐risk clinic. Results : Throughout pregnancy, glycemic control was closely monitored using continuous glucose monitoring, demonstrating excellent control (mean glucose 106 mg/dL, time in range 93%) without hypoglycemia. Nutritional status remained stable under dietitian supervision, with only mild, asymptomatic hypocalcemia detected in the third trimester. Maternal weight gain and fetal growth were appropriate. At 38 + 4 weeks, she delivered a healthy infant via spontaneous vaginal delivery. Neonatal outcomes were unremarkable, with normal development during two years of follow‐up. Conclusion : This case demonstrates that successful pregnancy following pancreaticoduodenectomy is feasible with structured multidisciplinary care. Continuous metabolic monitoring, proactive nutritional assessment, and coordinated obstetric, endocrine, and gastroenterology follow‐up are essential for optimizing outcomes. To our knowledge, this report is among the few to describe detailed glycemic monitoring using continuous glucose monitoring alongside favorable long‐term neonatal outcomes, highlighting a practical framework for managing this rare but increasingly relevant clinical scenario.

Heidi Kruit 1 ; Leena Rahkonen 2 1 Helsinki University Hospital, Helsinki, Finland; 2 Aalto University, Espoo, Finland Objective : The rate of induction of labor (IOL) is increasing alongside maternal age and obesity, impacting maternal morbidity, healthcare costs, and childbirth experience. This study aimed to evaluate the association between IOL indications and delivery outcomes to support clinical decision‐making regarding risks and benefits of IOL. Study Design : This retrospective 5‐year cohort study was conducted at Helsinki University Hospital, a large tertiary academic center, including 65,947 deliveries between 2017 and 2021. During this period, the IOL rate was 28% and cesarean delivery (CD) rate 17%. Women undergoing IOL at ≥37 weeks with singleton cephalic pregnancies were included. The study was approved by the institutional review board (HUS/3172/2018; HUS/54/2019). Primary outcomes were CD and composite adverse neonatal outcome (perinatal death, NICU admission, umbilical artery pH ≤ 7.05, base excess <−12, or 5‐minute Apgar score <7). Results : The cohort included 16,377 women. IOL was initiated by cervical ripening in 12 985 (79.3%) women, with balloon catheter being the most common method ( n  = 9658, 59.0%). The most common indications were post‐term pregnancy (31.3%) and prelabor rupture of membranes (26.3%). Overall CD rate was 20.3%, higher in nulliparas (28.9%) than multiparas (10.3%; p  < 0.001, OR 3.5, 95% CI 3.2–3.8). Composite adverse neonatal outcome occurred in 12.7%. The highest CD rate (27.9%) was associated with hypertensive disorders (aOR 1.6, 95% CI 1.4–1.8), and the lowest (10.0%) with maternal exhaustion. Neonatal adverse outcomes were lowest in fear of childbirth (7.4%) and highest in fetal indications (19.1%). Logistic regression showed nulliparity, unfavorable cervix, maternal age ≥35 years, height <164 cm, and BMI ≥ 30 as independent CD risk factors. Conclusion : IOL indication influences CD and neonatal outcomes, but parity and maternal characteristics remain key determinants. These findings have important implications for individualized counseling and management of IOL.

Marwan Odeh 1 ; Maya Frank Wolf 2 ; Rivka Nassis 1 ; Lior Lowenstein 2 ; Inshirah Sgayer 3 1 Galilee Medical Center, Nahariya; 2 Raya Strauss Wing of Obstetrics and Gynecology, Galilee Medical Center; Azrieli Faculty of Medicine, Bar‐Ilan University, Nahariya, Israel; 3 Galilee Medical Center, Nahariya, Israel Objective : To identify antepartum characteristics associated with emergency cesarean delivery in pregnancies complicated by placenta previa. Study Design : This retrospective cohort study included all singleton pregnancies with placenta previa managed at a tertiary medical center from January 2014 to August 2024. Placenta previa was defined sonographically at ≥24 weeks. Women were categorized as having either an emergency cesarean delivery—performed for acute bleeding, or spontaneous labor—or a planned elective cesarean. Maternal characteristics, placental location, and detailed bleeding features were compared between groups. Variables associated with emergency delivery in univariate analysis were entered into a multivariable logistic regression model. Results : A total of 262 women met inclusion criteria; 103 (39.3%) required an emergency cesarean delivery. Maternal characteristics were similar between groups. Several bleeding‐related features differed significantly: a first bleeding episode before 32 weeks (35.0% vs. 22.0%, p  = 0.023), moderate or heavy bleeding (24.3% vs. 10.1%, p  = 0.003), and ≥2 bleeding episodes (39.8% vs. 23.3%, p  = 0.006) were all more common in the emergency group. In multivariable analysis, moderate or heavy bleeding (adjusted OR 2.63, 95% CI 1.28–5.39) and ≥2 bleeding episodes (adjusted OR 2.20, 95% CI 1.20–4.03) remained independent predictors of emergency delivery. Women requiring emergency delivery delivered earlier (34.8 vs. 37.0 weeks, p  < 0.001) and had higher rates of preterm birth, lower birthweight, greater NICU admission, and increased neonatal mortality. Among women who required emergency delivery, an anterior placenta independently predicted delivery before 32 weeks (adjusted OR 4.76, 95% CI 1.24–18.18). Conclusion : Bleeding history provides useful clues for anticipating which women with placenta previa may require unplanned delivery, allowing for more attentive surveillance.

Maya Frank Wolf 1 ; Anna Levine 2 ; Liron S. Kinog 2 ; Ala Aiob 3 ; Lior Lowenstein 1 ; Marwan Odeh 3 ; Inshirah Sgayer 4 1 Raya Strauss Wing of Obstetrics and Gynecology, Galilee Medical Center; Azrieli Faculty of Medicine, Bar‐Ilan University, Nahariya, Israel; 2 Galilee Medical Center, Nahariya, HaZafon; 3 Galilee Medical Center, Nahariya; 4 Galilee Medical Center, Nahariya, Israel Objective : To compare maternal and neonatal outcomes following emergency versus prophylactic cervical cerclage in women with singleton pregnancies. Study Design : This retrospective cohort study included all the women who underwent McDonald cervical cerclage at a tertiary medical center during 2010–2024 and delivered at ≥23 weeks. Women were categorized according to prophylactic cerclage, placed electively based on obstetric history without cervical changes; and emergency cerclage, performed for cervical shortening or painless dilation in the absence of contractions, bleeding, or ruptured membranes. Clinical and delivery data were retrieved from electronic records. Outcomes included gestational age at delivery, spontaneous preterm birth <37 and <32 weeks, obstetrical complications, and neonatal morbidity and mortality. Results : Cerclage was performed earlier in the prophylactic ( n  = 127) than the emergency ( n  = 54) group (14.1 vs. 18.4 weeks, p  < 0.001). Significant differences were not observed between the groups in the mean gestational age at cerclage removal (37.1 ± 3.4 vs. 36.9 ± 3.2 weeks, p  = 0.746) or the mean gestational age at delivery (38.0 vs 37.9 weeks, p  = 0.981). Nor did the proportions differ significantly of spontaneous preterm birth <37 weeks (18.1% vs. 22.2%, p  = 0.541) or <32 weeks (7.1% vs. 5.6%, p  = 1.00). Neonatal outcomes, including birthweight, admission to the neonatal intensive care unit, respiratory complications, and neonatal mortality, were comparable. Multivariable analysis confirmed that cerclage, whether prophylactic or emergency, was not independently associated with spontaneous preterm birth <37 weeks. Prior preterm birth increased the risk (aOR = 6.21, 95% CI 1.08–35.70, p  = 0.041), and progesterone use was associated with a lower risk (aOR = 0.11, 95% CI 0.015–0.83, p  = 0.032). Conclusion : Emergency cerclage was associated with comparable maternal and neonatal outcomes as prophylactic cerclage, suggesting its safety and effectiveness, following careful patient selection.

Ramiro J. Diaz 1 ; José Garcia 2 ; Melanie Porter 2 ; Orlando Mogena 2 ; Patricia Polanco 2 ; Rebeca Ostreicher 2 ; Cecil Felix 2 1 Medicina Fetal Dominicana, Santo Domingo; 2 Medicina Fetal Dominicana, Santo Domingo, Dominican Republic Objective : To evaluate embryoscopy as a technique for direct anatomical assessment of the embryo following early pregnancy loss, and for obtaining uncontaminated embryonic genetic material. This approach aims to distinguish embryonic findings from placental and chorionic genetic contributions while avoiding maternal cell contamination. Study Design : This prospective multicenter study was conducted at three fetal medicine centers in the Dominican Republic (Santo Domingo, Santiago de los Caballeros, and San Francisco de Macorís) between 2022 and 2026. Fifteen embryoscopies were performed after early pregnancy loss between 6 and 10 weeks of gestation. Embryonic tissue samples were obtained from both singleton and multiple pregnancies and analyzed using chromosomal microarray testing (Products of Conception, POC) in order to determine the genetic condition of each case. Results : All 15 embryoscopy procedures were successfully completed, demonstrating 100% feasibility with no procedure‐related adverse events. Adequate anatomical visualization and retrieval of embryonic genetic material were achieved in all cases. Chromosomal microarray analysis identified aneuploidy in 75% of cases, while 25% showed normal results. Embryoscopy enabled the detection of early structural abnormalities not identifiable by ultrasound at this gestational age. Observed findings included facial anomalies consistent with triploidy as well as axial developmental alterations associated with trisomies. These anatomical observations provided additional phenotypic correlation to the cytogenetic results. Conclusion : Embryoscopy represents a valuable complementary approach in early pregnancy loss by enabling direct embryonic anatomical assessment alongside cytogenetic diagnosis while reducing the limitations of maternal contamination and placental mosaicism. This integrated evaluation may improve diagnostic accuracy and support reproductive counseling and recurrence risk assessment.

Giovanni Morganelli 1 ; Ariane Jeanne Odette Kiener 1 ; Corinne Labadini 1 ; Tullio Ghi 2 ; Caterina Neri 3 ; Carmelinda Martino 3 ; Angela Botta 3 ; Serafina Garofalo 3 ; Irene Cetin 4 ; Enrico Iurlaro 4 ; Michele Orsi 5 ; Valentina Romagnoli 6 ; Nicolas Mottet 7 ; Emily Hotton 8 ; Marcus Cabrera‐Dandy 9 ; Elena Greco 9 ; Stamatina Iliodromiti 9 ; Michael Magro 10 ; Josie O'Heney 10 ; Shogofa Maarij 10 ; Sarah Loveridge 11 ; Catherine McKenzie 11 ; Stefania Fieni 12 1 Azienda Ospedaliero‐Universitaria di Parma, Parma, Italy; 2 Department of Woman and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 3 IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; 4 S.C Ostetricia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; 5 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; 6 Università degli Studi di Milano, Milano, Italy; 7 Besançon University Medical Center (CHU Besançon Franche‐Comté), Besançon, France; 8 Gloucester Hospitals NHS Foundation Trust, Gloucester Hospitals NHS Foundation Trust, United Kingdom; 9 Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom; 10 Queens Hospital ‐ Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, United Kingdom; 11 East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom; 12 University of Parma, Parma, Italy Objective : To evaluate neonatal outcomes following real‐world use of the OdonAssist device for operative vaginal delivery (OVD), with focus on device‐related neonatal trauma. Study Design : We conducted a multicenter retrospective observational cohort study of OVDs performed with OdonAssist between June 2025 and March 2026 across hospitals in France, Italy, and the United Kingdom. Cases requiring cesarean delivery or sequential use of other instruments were excluded. The primary outcome was neonatal traumatic morbidity, defined as cephalohematoma, subgaleal hemorrhage, fractures, or clinically significant soft tissue injury. Outcomes were descriptively compared with published data on vacuum and forceps deliveries. Maternal outcomes, including obstetric anal sphincter injuries (OASIS), were also assessed. Results : Among 243 attempted Odon‐assisted deliveries, 163 (67.1%) were successfully completed using OdonAssist alone and included in the analysis (Table 1). No cases of major neonatal trauma or intracranial hemorrhage were observed while minor trauma was rare (1/163, 0.6%). The incidence of neonatal injury was negligible compared with published figures of approximately 9–10 per 1000 births with vacuum and forceps. Conclusion : In this multicenter cohort, OdonAssist use was not associated with major neonatal trauma, and minor injuries were uncommon. These findings suggest a favorable trauma‐related safety profile. However, the non‐comparative design and limited sample size warrant cautious interpretation. Prospective controlled studies are needed to confirm these findings and define the role of OdonAssist in OVD.

Eleonora Biancareddu 1 ; Sofia Roero 1 ; Monica Minopoli 1 ; Thomas Hanton 2 ; Veronica Giorgione 2 ; Nikolas Sokratous 1 ; Amarnath Bhide 3 ; Basky Thilaganathan 3 1 St George's University Hospitals NHS Foundation Trust, London, United Kingdom; 2 St George's University Hospitals NHS Foundation Trust, St George's University Hospitals NHS Foundation Trust, United Kingdom; 3 St George's University Hospital, London, United Kingdom Objective : Risk‐assessment for adverse pregnancy outcomes is conventionally based on a checklist‐based identification of maternal risk factors. The value of this anamnesistic approach using ACOG, NICE or other checklists has recently been questioned. The aim of this study was to compare the relative performance of first‐trimester combined preeclampsia (PE) screening for predicting adverse pregnancy outcomes. Study Design : This is a retrospective cohort study of 20,498 singleton pregnancies that underwent first‐trimester combined screening for PE using the Fetal Medicine Foundation (FMF) algorithm. Relative risks (RRs) were calculated for composite adverse pregnancy outcomes (CAPO: preterm birth, small‐for‐gestational age [SGA], hypertensive disorders of pregnancy and stillbirth) at different risk thresholds. RRs were also calculated for individual anamnesistic maternal risk factors. Results : First‐trimester combined screening risks demonstrated a consistent association to CAPO with. For CAPO, RR decreased from 1.74 (95% CI 1.65–1.83) to 1.30 (95% CI1.27–1.32) for risks of >1:50 and >1.200, respectively. All maternal risk factors had RRs less than 1.12, except for chronic hypertension with an RR of 4.9 (95% CI 3.55–7.01). ROC analysis demonstrated superior performance of the FMF algorithm versus an anamnesistic NICE checklist‐based approach for the prediction of not just preeclampsia, but all composite adverse pregnancy outcomes. Conclusion : These findings support the use of first‐trimester combined screening for preeclampsia as a more effective approach than traditional anamnesistic risk assessment. The FMF algorithm is not only predictive of preeclampsia, but also of other adverse pregnancy outcomes, suggesting a commonality in the etiological pathways for these disorders.

Jerri A. Waller 1 ; Katie Kolb 1 ; Tetsuya Kawakita 1 ; Gloria Too 1 ; Erkan Kalafat 2 ; Marwan Maayeh 1 ; Rebecca Horgan 1 ; George R. Saade 1 ; Lindsay Robbins 1 1 Eastern Virginia Medical School at Old Dominion University, Norfolk, VA; 2 Koç University Hospital, Istanbul, Turkey Objective : Evaluate maternal cardiovascular disease outcomes by composite severe maternal morbidity (SMM) of Black pregnant patients with cardiovascular disease compared to White pregnant patients within 1 year following delivery. Study Design : This is a retrospective cohort study of all pregnant patients aged 18–45 years old with a diagnosis of cardiovascular disease who delivered at our institution from January 1, 2015 and February 1, 2021. Patients without a diagnosis of cardiovascular disease were excluded. The primary outcome was composite SMM as defined by the Centers for Disease Control (CDC). The rate of SMM was evaluated in White vs. Black pregnant patients at 12 months following delivery. Maternal demographics and co‐morbidities were collected. Comparisons were made with the Mann‐Whitney‐U or chi squared test. Univariable and multivariable analyses were conducted with logistic regression. Results : A total of 612 patients with cardiovascular disease were included in the study, of which 345 (56.4%) were White and 267 (43.6%) were Black. Black patients compared to White patients had a higher BMI, had increased gravidity and parity, were less likely to married, and were more likely to have public insurance (Table 1). Black patients had greater rates of Type 2 diabetes, chronic hypertension, preeclampsia with severe features, fetal growth restriction and intrauterine fetal demise (Table 1). White patients had greater rates of gestational hypertension (Table 1). Black patients experienced greater rates of SMM up to six months postpartum (6.0% vs. 1.7%, p  = 0.010) and twelve months postpartum (6.7% vs. 2%, p  = 0.007) (Table 1). After adjusting for confounders, odds of SMM remained higher among Black patients up to 12 months postpartum (aOR 3.04, 1.24–8.26, p  = 0.020) (Table 2). Conclusion : Race was an independent risk factor for SMM up to one year postpartum in patients with cardiovascular disease, with Black patients having a 3.04 times greater odds of experiencing severe maternal morbidity than White patients.

Idan Shamay 1 ; Amir Wolfovitz 2 ; Naphtali Justman 2 ; Nuelle Almog 3 ; Nizar Khatib 2 ; Ido Solt 2 ; Yaniv Zipori 2 1 Rambam Health Care Campus, Haifa; 2 Rambam Health Care Campus, Haifa, Israel; 3 The Ruth and Bruce Rappaport Faculty of Medicine, Technion‐Israel Institute of Technology, Haifa, Israel Objective : To evaluate the association between polyhydramnios and maternal perception of decreased fetal movements (DFM) and to determine if a volume‐dependent threshold exists for this effect. Study Design : A retrospective case‐control study was conducted, including 7215 singleton pregnancies (2006–2025). The study group comprised 2066 women with polyhydramnios (amniotic fluid index, AFI >25 cm or maximal vertical pocket >8 cm), and the control group included 5149 women with normal amniotic fluid volume. DFM rates were compared across gestational age groups and polyhydramnios severity. Results : While the overall rate of DFM was similar between groups (7.5% vs 7.9%, p  = 0.55), a significant “volume‐dependent threshold” was identified. Women with moderate‐to‐severe polyhydramnios (AFI ≥30 cm) reported DFM at nearly double the rate of those with mild polyhydramnios (13.7% vs 7.2%, p  < 0.001). Furthermore, DFM was significantly more prevalent in the polyhydramnios group during the early third trimester (0.8% vs 0.3%, p  = 0.006) and the late preterm period (4.5% vs 1.9%, p  < 0.001), whereas this trend reversed at term. Polyhydramnios was associated with higher rates of cesarean delivery (36.4% vs 27.5%), neonatal hypoglycemia (4.3% vs 2.1%), and neonatal intensive care unit admissions (8.3% vs 6.7%; all p  < 0.001). Conclusion : Polyhydramnios significantly influences maternal perception of fetal activity in a volume‐dependent and gestational age‐specific manner. High amniotic fluid volumes (AFI ≥30 cm) may act as a physical buffer, masking fetal movements. Clinical reports of DFM in women with significant polyhydramnios warrant increased vigilance and objective assessment.

Elizabeth Mercer; Katelyn Corpuz; Mary Tschann; Cathlyn Sullivan; Bliss Kaneshiro; Marguerite Lisa Bartholomew; Pai‐Jong Stacy Tsai University of Hawaii, Honolulu, HI Objective : Acute rheumatic fever rates in Hawai'i are double those in the continental U.S., particularly among Native Hawaiian and Pacific Islander (NHPI) populations. We evaluated maternal outcomes for pregnant patients with rheumatic heart disease (RHD) in a predominantly NHPI population. Study Design : We conducted a retrospective case series of pregnant patients with RHD who delivered at Queen's Medical Center in Honolulu, HI from 2012 to 2025. The sample consisted of 25 patients with a total of 27 pregnancies. Clinical data was obtained and summarized descriptively. Results : Of the 25 patients with RHD, 84% (21) were NHPI. The most common valvular lesions were tricuspid regurgitation (81%, 22), mitral stenosis (59%, 16), and mitral regurgitation (56%, 15); 48% (13) patients had multiple valvular lesions. RHD was known prior to pregnancy in 70% (19), and 33% (9) had undergone valve replacement(s) (mechanical: 2 and prosthetic: 9). The average gestational age at first prenatal visit was 16 weeks with average delivery at 37 weeks. Pregnancy complications included antepartum ICU stay > 24 hours (22%, 6), pulmonary edema (26%, 7), and stillbirth (7.4%, 2) (Table 1). Postpartum follow‐up occurred in 67% (16) with a primary OB/GYN and 67% (16) with a cardiologist within two months. Postpartum complications included ICU stay > 24 hours (29%, 7), valve surgery (21%, 5), and pulmonary edema (29%, 7) within 2 months of delivery (Table 2). One maternal death occurred three weeks postpartum. Conclusion : To our knowledge, this is the first description of RHD in pregnancy within a largely NHPI population. Identifying common complications can guide optimization of care, including increased antepartum surveillance given the risk of stillbirth and referral for delivery at a level IV maternal care facility. Advancing health equity requires identifying and addressing structural barriers to establishing early prenatal care and postpartum follow‐up. Expanding access through culturally responsive, community‐based care models is essential to reducing preventable maternal morbidity and mortality in this population.

Mikko Tarvonen 1 ; Tommi Riehunkangas 1 ; Ville Tuppurainen 1 ; Riina Jernman 1 ; Vedran Stefanovic 1 ; Paulus Torkki 2 ; Mika Gissler 3 ; Sture Andersson 4 1 Helsinki University Hospital, Helsinki, Finland; 2 University of Helsinki, Helsinki, Finland; 3 Department of Data and Analytics, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; 4 Helsinki University Hospital and University of Helsinki, Helsinki, Finland Objective : To compare the true cost of optimal versus substandard obstetric care in cases with and without neonatal hypoxic‐ischemic encephalopathy (HIE). Study Design : This retrospective economic analysis included a 20‐year (2005–2024) cohort of 317,126 term singleton deliveries with 314 cases of HIE across 7 hospitals within the Helsinki University Hospital district, Finland. Optimal care was defined as timely delivery in response to nonreassuring fetal status, while substandard care referred delayed or missed responses. The primary outcome was the direct neonatal healthcare cost from birth to hospital discharge. Secondary outcomes included the relative risk (RR) of HIE and the incremental cost per disability‐free life year (DFLY) gained by age 4. Costs across 4 groups (optimal or substandard care, with or without HIE) were compared using generalized linear models. The study was powered at 90% to detect a ≥$1,448 mean cost difference. Results : The mean cost per newborn was lower in the optimal care group compared with the substandard care group, irrespective of HIE occurrence ($1,269 vs. $2,807; mean difference $1,537 [+ 121%]; 95% CI $662–$2,413; p  < .001). The largest disparity was between neonatal HIE cases after substandard care and cases without HIE under optimal care ($28,315 versus $988; mean difference $27,327 [+ 2,766%]; 95% CI $19,721–$34,779; p  < .001). Optimal care yielded a 4‐year DFLY gain of 0.06 per newborn (95% CI 0.05–0.07), with an incremental cost of $–25,617 (95% CI $–40,221 to $–11,013; p  < .001) per DFLY gained. The incidence of HIE was 1.53% (95% CI 1.21–1.93) in the substandard care group, representing a 20‐fold increase in risk (RR 19.60; 95% CI 15.00–25.50) compared with the optimal care group (0.08%; 95% CI 0.07–0.09; p  < .001). Conclusion : Optimal obstetric care was more cost‐effective, less costly, and clinically more effective, lowering average healthcare costs per newborn while reducing the incidence of HIE compared with substandard care.

Gil Gutvirtz 1 ; Tamar Wainstock 2 ; Eyal Sheiner 1 1 Soroka University Medical Center, Beer Sheva, Israel; 2 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel Objective : A single umbilical artery (SUA) is the most common form of umbilical cord pathology. When detected prenatally, additional fetal evaluation is warranted since SUA may also present with other fetal chromosomal and structural malformations. Syndromic SUA has been associated with offspring respiratory morbidity, but even isolated SUA (iSUA) may harbor added complications for the offspring. This study aimed to investigate a possible relationship between isolated SUA and risk for long‐term respiratory morbidity of the offspring. Study Design : A retrospective population‐based analysis of singleton deliveries, born in a tertiary hospital between 1991–2021, was conducted. Pregnancies complicated by chromosomal abnormalities or major fetal malformations were excluded to include only cases of iSUA. A comparison of long‐term respiratory morbidity was made between children with and without an iSUA, through inpatient and outpatient medical records. Cumulative incidence was evaluated using Kaplan‐Meier survival analysis, and a multivariable Cox proportional hazards model adjusted for possible confounders. Results : Of 232,476 singleton deliveries, 136 were diagnosed with an isolated SUA. The overall respiratory morbidity rate was lower in children with iSUA (Table), mainly driven by lower rates of asthma (17.6% in iSUA vs. 32.2%, p  < 0.001). Lower cumulative incidence of respiratory morbidity was also observed in the Kaplan‐Meier survival curve (Figure), and the adjusted analysis, controlling for maternal and gestational age, diabetes mellitus, hypertensive disorders, intrauterine growth restriction and cesarean delivery, found that the presence of iSUA had an overall protective effect for the offspring (Table). Conclusion : The presence of iSUA was associated with a significantly lower risk for asthma in the newborn, leading to an overall lower incidence of long‐term respiratory morbidity in affected children. The observed association should be further validated in prospective, multicenter studies.

Gil Gutvirtz 1 ; Tamar Wainstock 2 ; Eyal Sheiner 1 1 Soroka University Medical Center, Beer Sheva, Israel; 2 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel Objective : Maternal chronic hypertension (cHTN) has been associated with various adverse pregnancy and neonatal outcomes, exposing the offspring for both short and long‐term adverse consequences. With the increase in pregnancies of advanced maternal age, a concomitant increase in pregnancies with maternal cHTN is expected. In this study we investigate the long‐term infectious morbidity of offspring to maternal cHTN, unrelated to preeclampsia. Study Design : We conducted a population‐based retrospective cohort study of singleton deliveries in a tertiary hospital between the years 1991–2021. Offspring long‐term (up to the age of 18) infectious morbidity was compared between deliveries of women with cHTN and deliveries of women without any hypertensive disorder of pregnancy. The long‐term infectious morbidity was compared using diagnoses from both community clinics and hospitalizations of offspring involving an infectious morbidity. A Kaplan–Meier survival curve was used to compare the cumulative incidence of infectious disease of the offspring and a Cox regression model was constructed to control for relevant confounders. Results : A total of 342,365 singleton deliveries were included. Among them, 3097 (0.9%) were of mothers with cHTN. Offspring total infectious morbidity rate was significantly higher in children exposed to maternal cHTN as compared with children from pregnancies without hypertensive disorders (Table). Likewise, the cumulative incidence of infectious morbidity over time was significantly higher for children of mothers with cHTN (Figure). Using a Cox regression model, controlling for maternal and gestational age, maternal cHTN was noted as an independent risk factor for long‐term infectious morbidity of the offspring (adjusted HR = 1.1, 95% CI 1.03–1.13, p  < 0.001). Conclusion : In our cohort, maternal chronic hypertension was found to be an independent risk factor for long‐term pediatric infectious morbidity of the offspring. However, the absolute risk remains relatively small and further studies are needed to explore this possible association.

Gil Gutvirtz 1 ; Tamar Wainstock 2 ; Eyal Sheiner 1 1 Soroka University Medical Center, Beer Sheva, Israel; 2 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel Objective : The use of fertility treatments among women of advanced maternal age (AMA) has risen significantly. These pregnancies carry unique risks that may affect offspring health. While short‐term outcomes have been studied, data on long‐term morbidity in offspring conceived via fertility treatments, particularly in the context of AMA, remain limited. We sought to investigate the impact of fertility treatments at AMA on offspring long‐term infectious morbidity. Study Design : We conducted a retrospective cohort study of singleton deliveries of primiparas aged 3 40 who delivered between the years 1991–2021 at a tertiary center. The long‐term infectious morbidity of offspring conceived via fertility treatments was compared to those from spontaneous pregnancies, using data from both community clinics and hospitalization records. The diagnoses of infectious morbidities were based on ICD‐9 codes. A Kaplan–Meier survival curve was used to compare the cumulative incidence of infectious morbidity and a Cox regression model was constructed to control for confounders. Results : A total of 276 women aged ≥40 in their first delivery were included in the study. Of them, 166 (60.1%) conceived using fertility treatments and 110 (39.9%) had spontaneous pregnancies. Offspring long‐term infectious morbidity (Table) as well as the cumulative incidence of infectious morbidity over time (Figure) was significantly higher in those conceived via fertility treatments compared to spontaneously conceived offspring. The Cox regression model, controlling for maternal age, gestational age, diabetes mellitus, hypertensive disorders of pregnancy and cesarean delivery, found that the use of fertility treatments in women aged ≥40 was an independent risk factor for long‐term infectious morbidity of their offspring (adjusted HR = 1.68, 95% CI 1.21–2.34, p  = 0.002). Conclusion : Fertility treatments in women aged 40 and above were linked to increased long‐term infectious morbidity in offspring. Further research into the impact of assisted reproduction at advanced maternal age is needed.

Nadine Mathieu 1 ; Tanja Knopp 2 ; Dana Azar 3 ; Kristina Vrotniakaite‐Bajerciene 2 ; Daniel Surbek 1 ; Alessandro Casini 4 ; Anne Angelillo‐Scherrer 2 ; Johanna Anna Kremer Hovinga Strebel 2 ; Jarmila A. Zdanowicz 1 ; Justine Brodard 2 On behalf of the Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 1 Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 2 Department of Hematology and Central Hematological Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 3 Stago, Stago, Paris, France; 4 Angiologie et Hémostase, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland Objective : Pregnancy is characterized by progressive hypercoagulability, while postpartum hemorrhage (PPH) remains a major cause of maternal morbidity. Conventional coagulation tests provide limited insight into the balance between procoagulant and anticoagulant pathways. Thrombin generation assays allow global functional assessment of coagulation. We aimed to assess longitudinal changes of thrombin generation during pregnancy and their association with PPH using the automated ST Genesia ® system. Study Design : In this prospective observational study, 69 healthy pregnant women were enrolled in the first trimester. Blood samples were collected in all trimesters and at 6 weeks postpartum. Thrombin generation was measured using ST Genesia ® with BleedScreen and ThromboScreen assays, with and without thrombomodulin. Parameters included endogenous thrombin potential (ETP), peak height, lag time, velocity index and thrombomodulin‐mediated ETP inhibition. PPH was defined as blood loss ≥500 mL after vaginal delivery or ≥1000 mL after cesarean section. Results : PPH occurred in 10% (7/69). ETP, peak height and velocity index were significantly increased during pregnancy compared with non‐pregnant controls, while lag time remained unchanged. Thrombomodulin‐mediated ETP inhibition was reduced in all trimesters, indicating decreased protein C/S pathway sensitivity. No differences were observed between trimesters. At 6 weeks postpartum, thrombin generation parameters returned to non‐pregnant levels. Antepartum ETP was not associated with severe PPH, although a trend toward faster thrombin generation was observed in women with severe PPH. Conclusion : Pregnancy is associated with a sustained procoagulant shift with enhanced thrombin generation and reduced thrombomodulin‐mediated anticoagulant regulation, followed by normalization postpartum. Antepartum thrombin generation (ETP) was not associated with severe PPH. Larger studies are needed to evaluate its predictive value for obstetric risk stratification.

Talia Suner 1 ; Caroline Strong 1 ; James D. Toppin 2 ; Brian James 1 ; Joseph R. Biggio, Jr. 3 ; Frank B. Williams 3 1 Ochsner Clinic Foundation, New Orleans, LA; 2 Ochsner Health, Ochsner Health/New Orleans, LA; 3 Ochsner Health, Ochsner Health, LA Objective : Adverse pregnancy outcomes (APOs) predict cardiovascular disease (CVD) later in life. Systematic risk stratification via validated tools such as the American Heart Association's PREVENT Calculator during pregnancy/postpartum period is invalid due to physiologic serum cholesterol perturbations. We created a Cardio‐Obstetric PostPartum Risk (COPPR) Score to systematize CVD risk stratification at time of delivery hospitalization discharge with a goal of informing long term cardiovascular care. We hypothesize that low socioeconomic status (SES) is associated with higher COPPR Scores, indicating increased long‐term CVD risk. Study Design : We performed a retrospective cohort study of pregnancies delivering at a single tertiary‐care hospital from February to May 2025. Patients with hypertensive disorders of pregnancy (HDP), captured by ICD‐10 code, were included. Literature review informed selection of factors and coefficients associated with CVD risk (Table). Each patient was scored via manual chart review, generating a baseline and delivery discharge COPPR Score. We compared patients by payor status, with Medicaid insurance a proxy for low SES. Baseline characteristics were compared via chi square or Mann Whitney U test, where appropriate. The primary outcome of COPPR score was compared via Mann Whitney U test. Medians were generated with interquartile ranges (IQR). Alpha was set at 0.05. Results : Among 301 patients with HDP, 101 (33.6%) used Medicaid. Public payor patients were younger (29 vs 31 years, p  = 0.01) & more likely to be Black (61 vs 23%, p  < 0.01) or Hispanic (13 vs 5%, 0.02); other characteristics & comorbidities were similar. While baseline COPPR scores were not different between groups (2 [IQR 0–3] vs 2 [0–3], p  = 0.56), discharge COPPR scores were higher among low SES patients (4 [2–5] vs 4 [3–6], p  = 0.02, Figure), consistent with higher prevalence of APOs. Conclusion : COPPR Score is a novel risk stratification tool that can prioritize postpartum patients at highest risk for CVD. APO‐related CVD risk among low SES patients highlights the need for pathways to long term cardiovascular care.

Lena J. Volpe 1 ; Colleen Judge‐Golden 2 ; Persephone L. DShaun 3 ; Sydney Lenzini 2 ; Brittney R. Williams 3 ; Joesph M. Feinglass 3 ; Charlotte M. Niznik 2 ; Stacy Bailey 4 ; Nivedita Potapragada 5 ; Claudia Kazmirak 2 ; Olufunmilayo M. Badejo 3 ; Tiwadeye Lawal 3 ; William A. Grobman 6 ; Lynn M. Yee 3 1 Northwestern Medicine, Northwestern Medicine / Chicago, IL; 2 Northwestern University, Chicago, IL; 3 Northwestern University Feinberg School of Medicine, Chicago, IL; 4 Northwestern Unversity, Chicago, IL; 5 McGaw Medical Center of Northwestern University, Chicago, IL; 6 Brown University, Providence, RI Objective : Antenatal health services interventions require a detailed understanding of complex obstetric care processes. Process maps are visual representations of sequential tasks and decision points involved in care and help to navigate complexity, visualize collaboration, and identify areas for quality improvement. We aimed to develop a process map to model medical and organizational requirements of prenatal care across time, identify as needed or recurrent tasks, and represent subthemes of prenatal care. Study Design : As preparatory work for an antenatal patient navigation intervention, a multidisciplinary team was assembled consisting of physicians, nurses, patient navigators, researchers, administrators, and social workers at a large academic institution. Using standard process mapping methodology, we identified the activities and individuals involved in prenatal care and specified types of tasks (necessary or as needed, one‐time or recurrent) across time. The map was drafted using Lucidchart software and refined by expert feedback and iterative revisions across seven versions. Results : The Swim Lane Process Map was the optimal diagram for capturing complexity, tasks, time points, and subthemes of prenatal care based on iterative feedback and consideration of multiple map formats. Five subthemes were identified: Clinical Coordination, Maternal Surveillance, Fetal Surveillance, Counseling, and Consultant Referrals. Prenatal care was divided into the first trimester, second trimester, early third trimester, and late third trimester. We identified 74 discrete and 11 recurrent tasks in the prenatal and postpartum period (Figure 1). We also created process maps for special circumstances, including transfer of care/maternal hospital admission, perinatal complications, and pregnancy loss (Figure 2). Conclusion : Our study is among the first to model the multidisciplinary activities involved in high quality prenatal care across all stages of pregnancy. This map can guide prenatal care as well as support the development of effective interventions to reduce barriers to care and optimize patient support.

Evyatar Y. Almasi 1 ; Gil Gutvirtz 1 ; Tamar Wainstock 2 ; Eyal Sheiner 1 ; Gali Pariente 1 1 Soroka University Medical Center, Beer Sheva, Israel; 2 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel Objective : Post‐term birth (> 42 weeks) is associated with fetal post‐maturity, often characterized by increased meconium passage, reflecting functional activation of the gastrointestinal (GI) tract. While prolonged gestation may indicate structural GI maturity, it also exposes the fetus to hypoxic stress and placental insufficiency. The long‐term impact of post‐maturity on offspring GI health remains unclear. Thus, the present study was aimed to investigate the long‐term GI morbidity of offspring born post‐term. Study Design : This was a retrospective population‐based study of term singletons born between 1991–2021 at a tertiary medical center. Offspring were categorized into 3 gestational age groups: full term (39.0–40.6 weeks), late term (41.0–41.6 weeks), and post‐term (≥42.0 weeks). Long‐term GI morbidity data were obtained from hospitalization and outpatient records. A Kaplan‐Meier survival curve was used to compare the cumulative incidence of offspring GI morbidity among gestational age groups. A Cox regression model was constructed for the association between gestational age and offspring GI morbidity, adjusting for possible confounders. Results : The cohort included 103,797 singleton deliveries, of which 6.1% ( n  = 6,380) were late‐term and 0.7% ( n  = 780) were post‐term. Overall GI morbidity decreased as gestational age advanced (Table). Similarly, the cumulative incidence of GI morbidity decreased over time in the late‐ and post‐term groups compared to full term offspring (Figure). The Cox regression model, adjusted for maternal and gestational age, diabetes mellitus, hypertensive disorders and mode of delivery, found that late‐term births were independently associated with a reduced risk of long‐term GI morbidity, while post‐term birth had a comparable risk to full‐term birth (Table). Conclusion : Late‐term birth is associated with a modest reduction in long‐term offspring GI morbidity, potentially reflecting functional GI maturity. In contrast, post‐term birth offers no additional GI benefit compared to full term. Further prospective research is warranted to clarify mechanisms and clinical implications.

Sapir Ellouk 1 ; Gil Gutvirtz 2 ; Tamar Wainstock 3 ; Eyal Sheiner 2 1 Soroka University Medical Center, Beersheba, Israel; 2 Soroka University Medical Center, Beer Sheva, Israel; 3 Department of Epidemiology and Health Services Evaluation, Ben‐Gurion University of the Negev, Beer Sheva, Israel Objective : Endometriosis is a chronic inflammatory condition affecting up to 10% of women of reproductive age and is often linked to subfertility. However, the long‐term health outcomes of offspring born to mothers with endometriosis remain poorly understood. We hypothesized that the suboptimal intrauterine environment associated with endometriosis may impair embryonic growth and development, thereby increasing the risk of childhood morbidity. This study aimed to examine the association between maternal endometriosis and long‐term gastrointestinal (GI) morbidity in offspring. Study Design : We conducted a population‐based cohort study of singleton deliveries between 1991 and 2021 at a tertiary medical center. Offspring gastrointestinal (GI) morbidity, identified through community clinic and hospitalization records, was compared based on exposure to maternal endometriosis. Cumulative incidence was assessed using Kaplan‐Meier survival curves, and a Cox proportional hazards model was used to adjust for potential confounders. Results : The analysis included 232,476 deliveries, of which 224 (0.1%) were to mothers diagnosed with endometriosis. The overall rate of GI morbidity was significantly higher in offspring exposed to maternal endometriosis compared to unexposed children (34.4% vs. 26.5%, p  = 0.008; Table). Kaplan‐Meier survival analysis demonstrated an increased cumulative incidence of GI morbidity over time among offspring of mothers with endometriosis (log‐rank p  < 0.001; Figure). In a Cox proportional hazards model adjusted for gestational age, use of fertility treatments, and mode of delivery, maternal endometriosis was independently associated with a higher risk of long‐term GI morbidity in the offspring (adjusted hazard ratio [HR] 1.4, 95% CI 1.12–1.76, p  = 0.003; Table). Conclusion : Maternal endometriosis is independently associated with increased long‐term gastrointestinal morbidity in offspring, underscoring the potential impact of the intrauterine environment and the need for ongoing follow‐up in this population.

Basia Chmielewska 1 ; Chao Wang 2 ; Nick Macklon 3 ; Amarnath Bhide 1 ; Basky Thilaganathan 1 On behalf of St George's University Hospital 1 St George's University Hospital, London, United Kingdom; 2 Kingston Unviersity, London, United Kingdom; 3 London Women's Clinic, London, United Kingdom Objective : Hypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) are major manifestations of uteroplacental dysfunction. Current strategies for risk assessment rely on hospital‐based screening or diagnostic triage and do not provide continuous, personalised monitoring throughout pregnancy. Uric acid is closely linked to placental dysfunction, and salivary uric acid (sUA) reflects circulating concentrations, enabling non‐invasive remote measurement. This study evaluated whether serial, smartphone‐enabled self‐testing of sUA could predict adverse pregnancy outcomes related to uteroplacental dysfunction. Study Design : In this prospective observational cohort study, pregnant women were recruited at 20–22 weeks’ gestation at a tertiary hospital. Participants performed weekly salivary self‐testing using colorimetric uric acid strips until delivery, with results captured via a smartphone application. Images were analysed using RGB colour metrics. Primary outcomes were HDP and/or FGR. Logistic regression models incorporated four weeks of lagged RGB‐derived sUA metrics together with maternal characteristics. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and calibration metrics, stratified by gestational age at outcome. Results : Of 495 recruited participants, 318 women with complete longitudinal data were included in the final analysis; 36 (11.3%) developed HDP and/or FGR. A multivariable model combining maternal risk factors with four weeks of serial sUA measurements demonstrated good predictive performance. Discrimination was highest for preterm outcomes, with an AUC of 0.816 for prediction within one week at <37 weeks’ gestation and prediction remained acceptable at term (AUC 0.730). Conclusion : Remote serial self‐testing of salivary uric acid is feasible and shows moderate predictive ability for adverse pregnancy outcomes related to uteroplacental dysfunction. This non‐invasive approach has potential to complement existing screening and surveillance strategies by enabling continuous, personalised risk assessment throughout pregnancy.

Basia Chmielewska 1 ; Claire Pegorie 1 ; Michelle Jie 2 ; Basky Thilaganathan 1 On behalf of the Fetal Medicine Unit, St George's University Hospital 1 St George's University Hospital, London, United Kingdom; 2 St George's University Hospital, St George's Hospital, United Kingdom Objective : The randomised control Trial (RCT) of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE study) established its clinical efficacy for monitoring preterm fetal growth restriction (FGR). The objective of this study was to assess the clinical effectiveness of this protocol in a routine clinical setting with regards to the clinical outcomes, both overall and stratified by gestational age at FGR diagnosis. Study Design : This is a retrospective cohort study of singleton pregnancies with preterm FGR between January 2013 and July 2024 in a tertiary Fetal Medicine Unit. FGR was defined as an estimated fetal weight or abdominal circumference 95th centile. Main outcomes collected included perinatal survival, interval from diagnosis to delivery, and delivery indications. Results : 171 pregnancies met inclusion criteria. The median (IQR) gestation at FGR diagnosis and birth was 27 +6 week (25 +5 ‐29 +4 ). Overall intact neonatal survival was 90.6%, with rate of stillbirth and neonatal death being 2.9% and 5.8%, respectively. FGR diagnosis prior to 26 weeks was associated with three‐fold longer pregnancy prolongation compared to after 26 weeks (median of 31.0 versus 10.0 and 14.0 days; p  < 0.001). Below 32 weeks, the predominant indication for elective birth was abnormal computerised CTG with low short‐term variation (STV). Beyond 32 weeks’ gestation, abnormal umbilical artery Doppler and maternal indications such as preeclampsia was more frequent. Conclusion : The TRUFFLE monitoring protocol is clinically effective in managing early‐onset FGR outside a trial environment, achieving comparable perinatal outcomes to the original RCT. Routine integration of both Doppler and cCTG monitoring is crucial for optimal timing of birth with early FGR. Further research is needed to explore the benefits of more frequent or remote fetal monitoring.

Lillian Tushman 1 ; Julia Grande 2 ; Aung Lin 2 ; Anna E. Bortnick 2 ; Diana S. Wolfe 2 1 Albert Einstein College of Medicine, Bronx, NY; 2 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY Objective : The incidence of arrhythmias has risen sharply in recent years, but data about their clinical significance during pregnancy remains limited. We investigated comorbidities and outcomes among pregnant patients with arrhythmias who received care through an integrated cardio‐obstetrics program in the Bronx. Study Design : This retrospective cohort study analyzed all pregnant patients diagnosed with arrhythmias before or during pregnancy who were evaluated at a cardio‐obstetrics program between 2016 and 2024. Of the 166 patients screened, 99 met inclusion criteria and were stratified by arrhythmia type. A subgroup of 74 patients with atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation was isolated to enable direct comparison with existing national statistics that included only these diagnoses. The larger cohort was described, and data from the subgroup were compared to previously published data from the National Inpatient Sample. Chi‐square tests were used for comparative analysis. Results : Of the 99 patients analyzed, 30.30% were diagnosed with new arrhythmias during pregnancy. The mean BMI was 30.92, and the most common associated cardiac conditions were left atrial and ventricular dysfunction (10.10%), valvular heart disease (9.09%), and congenital heart disease (6.06%). The comparison subgroup had significantly higher rates of underlying hypertension (21.62%) and valvular disease (10.81%) than the national average for pregnant patients with arrhythmias. It also had significantly higher rates of gestational diabetes (20.27%), preeclampsia (20.27%), and preterm labor (18.92%). However, rates of cesarean delivery (CD) (36.49%) and intrauterine fetal demise (IUFD) (0%) were not significantly different from the national average. Conclusion : Despite the medical complexity of our cohort, CD and IUFD rates were comparable to the national average for pregnant patients with arrhythmias. Our cardio‐obstetrics program provides a promising model for identifying and managing arrhythmias during pregnancy.

Lillian Tushman 1 ; Julia Grande 2 ; Anna E. Bortnick 2 ; Diana S. Wolfe 2 1 Albert Einstein College of Medicine, Bronx, NY; 2 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY Objective : Hemodynamic changes in pregnancy are known to increase susceptibility to new arrhythmias and exacerbate existing ones. However, the clinical significance of arrhythmias in the absence of structural heart disease (SHD) remains understudied. We compared the obstetric and perinatal outcomes of pregnant patients with arrhythmias in the setting of SHD to those with structurally normal hearts, with the objective of clarifying whether underlying SHD elevates risk. Study Design : This retrospective cohort study evaluated pregnant patients with arrhythmias who received prenatal care at a cardio‐obstetrics program between 2016 and 2024. Of the 166 patients screened, 89 met inclusion criteria and were subdivided by the presence of SHD. Outcomes were compared, and Fisher's exact tests were used to assess significance. Results : There were no significant differences in the arrhythmia composition between the SHD and structurally normal heart groups. There were no significant differences in rates of preeclampsia, intrauterine growth restriction, preterm labor, cesarean delivery, labor dystocia, postpartum hemorrhage, arrhythmia‐related hospitalizations during pregnancy, and documented arrhythmias within the first year postpartum. However, patients with SHD were monitored with telemetry during labor at significantly higher rates than those with structurally normal hearts (52.94% and 15.28%, respectively). Similarly, there were no significant differences in rates of perinatal outcomes measured, including 5‐minute APGAR <7, NICU admission, small for gestational age fetus, large for gestational age fetus, and respiratory distress syndrome. Conclusion : In our cohort, pregnant patients with arrhythmias in the setting of SHD had similar rates of obstetric and perinatal complications to those with structurally normal hearts. These findings warrant further investigation in a larger cohort. Despite this, patients with SHD were more likely to be placed on telemetry during labor, indicating a need to better define which patients require continuous cardiac monitoring during labor.

Shahd Karrar; Symone McClain; Jamie Jospeh; Anqi Wang; Smitha Jogunoori; Ola Hadaya; Raminder Khangura Henry Ford Health, Detroit, MI Objective : Trial of labor after cesarean (TOLAC) may be offered to patients with a prior preterm cesarean delivery to achieve subsequent vaginal birth after cesarean (VBAC), but performance of the MFMU VBAC calculator in this population remains underexplored. We evaluated calculator performance among patients attempting TOLAC after a prior preterm cesarean delivery. Study Design : We conducted a retrospective cohort study of patients delivering within a single health system from 2021 to 2024 with one or two prior cesarean deliveries who attempted TOLAC after a prior preterm cesarean. Patients with contraindications to vaginal delivery, multifetal gestation, or fetal demise were excluded. ROC analysis assessed calculator performance; AUC and 95% confidence intervals were calculated overall and by early (< 34 weeks) versus late (≥34 weeks) preterm subgroups. Results : Of 92 patients, 69 (75.0%) achieved VBAC. Median gestational age of the prior cesarean pregnancy was 34 weeks 6 days (IQR, 33 weeks 0 days to 36 weeks 0 days). Overall AUC was 0.792 (95% CI, 0.681–0.904). Among 91 patients with subgroup data, the early preterm subgroup ( n  = 28) had an AUC of 0.813 (95% CI, 0.637–0.988) and an 86% VBAC rate, whereas the late preterm subgroup ( n  = 63) had an AUC of 0.782 (95% CI, 0.645–0.919) and a 70% VBAC rate. No uterine ruptures occurred. Conclusion : Patients with prior preterm cesarean delivery represent an understudied population in evaluations of VBAC prediction tools. The MFMU VBAC calculator showed acceptable‐to‐good performance in this population, supporting its use when counseling patients considering TOLAC.

Shahd Karrar; Symone McClain; Jamie Jospeh; Anqi Wang; Smitha Jogunoori; Ola Hadaya; Raminder Khangura Henry Ford Health, Detroit, MI Objective : Patients with prior preterm cesarean delivery are an understudied subgroup among candidates for trial of labor after cesarean (TOLAC). We evaluated vaginal birth after cesarean (VBAC) success rates overall and by timing of the prior preterm cesarean and explored characteristics associated with successful TOLAC. Study Design : We performed a retrospective cohort study of patients within a single health system from 2021 to 2024 with no more than two prior cesarean deliveries who attempted TOLAC after a prior preterm cesarean delivery. Patients ineligible for vaginal delivery, with multifetal gestation, fetal demise, or delivery outside the health system were excluded. The primary outcome was successful VBAC. Success was evaluated overall and by prior cesarean gestational age: early preterm (< 34 weeks) versus late preterm (34 to <37 weeks). Pre‐delivery variables were compared by outcome using the univariable Wilcoxon rank‐sum tests for continuous covariates and Fisher exact or Pearson chi‐square tests categorical variables. Results : Among 92 patients attempting TOLAC after prior preterm cesarean delivery, 69 (75.0%) achieved VBAC. Among 91 patients with subgroup data, 28 (31%) had a prior early preterm cesarean and 63 (69%) had a prior late preterm cesarean. VBAC occurred in 24/28 (86%) after prior early preterm cesarean versus 44/63 (70%) after prior late preterm cesarean ( p  = 0.11). Compared with failed TOLAC, successful VBAC was associated with prior vaginal delivery before the index cesarean (48% vs 22%, p  = 0.03), greater cervical dilation (3.0 vs 1.0 cm, p  < 0.001), greater effacement (60% vs 20%, p  < 0.001), and spontaneous labor (57% vs 18%, p  < 0.001). Other maternal, delivery, and neonatal characteristics did not differ. Conclusion : Among patients with prior preterm cesarean delivery who attempted TOLAC, VBAC success was 75% and did not differ significantly by timing of the prior preterm cesarean. Prior vaginal delivery, more favorable admission cervical exam, and spontaneous labor were associated with successful VBAC and may inform TOLAC counseling in patients with prior preterm cesarean delivery.

Aleksandra M. Zuk 1 ; Anjini Sam Chee 2 ; Maria Ospina 1 ; Graeme Smith 1 ; Shahirose Premji 1 ; Erna Snelgrove‐Clarke 1 ; Catherine L. Goldie 1 ; Jonas Shellenberger 2 ; Maria Velez 3 1 Queens University, Kingston, Canada; 2 ICES (Institute for Clinical Evaluative Sciences), Kingston, Canada; 3 McGill University, Montreal, Canada Objective : To estimate the incidence of vasa previa (VP) in Ontario and to evaluate clinical characteristics, indicators for preterm delivery and obstetric outcomes among persons diagnosed with VP stratified by mode of conception. Study Design : We conducted a retrospective, population‐based cohort study using linked health administrative data at ICES, Ontario, Canada. The Neonatal and Obstetric Health Outcomes among Women Diagnosed with Vasa Previa (NOHOW‐VP) is the largest population‐based VP study. Outcomes were stratified by mode of conception, comparing pregnancies conceived using assisted reproductive technology (ART) with those conceived without ART. Standardized differences (SD) >0.10 indicate a meaningful difference. Results : In total, over 1000 cases of VP were identified. The incidence rate of VP per 10,000 pregnancies increased from 3.36 (95% CI 3.01, 3.37) in 2002–2010 to 5.92 (95% CI 5.48, 6.39) in 2011–2021. Between 2011 and 2021, there was an almost 2‐fold increased risk of being diagnosed with VP in a subsequent pregnancy. When stratified by mode of conception, VP was more common among pregnancies conceived with ART (%) than among those conceived without ART (16.6% vs. 5.4%; SD >0.3). A similar pattern was observed among multiparous individuals with VP (SD >0.2). Among individuals with VP, gestational diabetes was more common in those with a history of ART than in those without ART (13.6% and 7.4%; SD >0.2), suggesting co‐occurrence of shared risk factors. Conclusion : This study represents the first and largest population‐based Canadian analysis of VP using health administrative data. The findings suggest that the incidence of VP has increased over time and that important clinical differences exist by mode of conception, particularly among pregnancies conceived with ART.

Ellinore Forslin; Alkistis Skalkidou; Andrea Hess Engström; Maria Jonsson Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden Objective : Obstetric anal sphincter injury (OASI) is associated with an increased risk of anal incontinence. Although postpartum pelvic floor muscle training (PFMT) is recommended, evidence of its effectiveness in preventing anal incontinence remains inconclusive. The objective of this study was to assess whether physiotherapist follow‐up after OASI is associated with pelvic floor dysfunction one year after delivery, particularly anal incontinence. Study Design : Registry‐based cohort study in Sweden (2015–2022). Cohorts were defined by differences in follow‐up routines across two hospitals and time periods (analysis 1: between hospitals and 2: within‐hospital over time), serving as proxies for postpartum physiotherapist follow‐up versus no follow‐up. The intervention, provided at 2 months postpartum, included PFMT, information and supportive care. The primary outcome was self‐reported anal incontinence one year postpartum. Secondary outcomes were other pelvic floor symptoms and satisfaction with the surgical outcome. Associations were analysed using multivariable logistic regression presented as adjusted Odds ratios (aORs) with 95 % confidence intervals (CIs). Results : A total of 443 women with OASI were included. Physiotherapist follow‐up was associated with a reduced risk of anal incontinence at one year postpartum (analysis 1 aOR: 0.57, 95% CI 0.33–0.99; analysis 2: aOR 0.31, 95% CI 0.10–0.97). Women who had been offered follow‐up were more likely to report satisfaction with the surgical outcome at one year; however this association was statistically significant only in analysis 1 (aOR 2.17, 95% CI 1.33–3.54). No differences were observed between groups regarding urinary incontinence or sexual dysfunction. Conclusion : Postpartum physiotherapist follow‐up after OASI may be associated with reduced prevalence of anal incontinence one year postpartum and may also improve satisfaction with the surgical outcome. Future research should evaluate whether optimising the timing and intensity of the intervention improves outcomes.

Stina Björkman 1 ; Marie Bladh 2 ; Sofia Sederholm Lawesson 3 ; Sara Bergstrand 4 ; Elisabeth Aardal 5 ; Martin Overgaard 6 ; Caroline Lilliecreutz 2 1 Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 2 Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 3 Department of Cardiology, Linköping University Hospital; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 4 Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 5 Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 6 Department of Clinical Biochemistry, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark Objective : The objective was to evaluate whether the sFlt‐1/PlGF ratio measured at admission for childbirth predicts peripartum adverse outcomes in women with Hypertensive Disorders of Pregnancy (HDP; Preeclampsia (PE) or Gestational Hypertension) and in normotensive women, since this remains unclear. Study Design : In this nested case‐control study the sFlt‐1/PlGF ratio was analyzed in biobanked serum using the BRAHMS Kryptor assay. Women with HDP and normotensive controls were identified via ICD‐codes and medical records were reviewed. Associations between the sFlt‐1/PlGF ratio and adverse maternal and neonatal outcomes were evaluated using multiple logistic regressions. Results : A total of 393 women were included, whereof 313 normotensive and 80 HDP cases. The median gestational length at sampling was 40 weeks in both groups ( p  = 0.632) (Table 1). Higher sFlt‐1/PlGF ratios were observed in women with obstetric and neonatal complications including severe maternal adverse outcomes ( p  = 0.005) operative birth ( p  = 0.004) and the neonatal composite adverse outcome ( p  < 0.001) (Table 2). However, these associations did not remain after adjustments for age, parity, gestational age and body mass index. Women with infants born small for gestational age or with low birth weight had higher sFlt‐1/PlGF ratio in the overall population and in the HDP subgroup ( p  < 0.001, 0.001, 0.003, 0.002) but the findings were not sustained in adjusted analyses. Women with severe PE and severe hypertension had higher sFlt‐1/PlGF ratios, confirmed in adjusted models (OR, 95% CI: 1.01, 1.01–1.02 for both). Conclusion : Overall, the sFlt‐1/PlGF ratio at admission for childbirth was not associated with adverse peripartum outcomes in neither normotensive nor hypertensive women, indicating that this ratio alone might not be a suitable marker for peripartum adverse outcomes. However, the association with severe PE and severe hypertension supports its potential diagnostic utility.

Michelle N. Harris 1 ; Ashleigh E. Aubin 1 ; Jessica C. Ehrig 1 ; Kelsey R. Kelso 1 ; Diana Villazana‐Kretzer 1 ; Ram R. Kalagiri 1 ; Niraj Vora 1 ; Birdie B. LaMarca 2 ; Lorena M. Amaral 2 ; Shannon S. Glaser 3 ; Mohammad N. Uddin 3 1 Baylor Scott White Medical Center Temple Clinic, Temple, TX; 2 University of Mississippi Medical Center, Jackson, MS; 3 Texas A&M University College of Medicine, Bryan, TX Objective : Preeclampsia (PreE), a hypertensive disorder affecting 5–10% of pregnancies globally, posing risks to maternal and fetal health. Despite extensive research, its pathogenesis remains unclear, and effective treatments are limited. Dysregulation of the renin‐angiotensin system (RAS), particularly elevated levels of (pro)renin, soluble (pro)renin receptor (sPRR), and placental PRR, is identified as a key contributor to PreE. These factors may serve as predictive biomarkers and therapeutic targets. Study Design : The study investigates the efficacy of handle‐region peptide‐Fc (HRP‐Fc), a decoy peptide, in rat models of PreE and explores (pro)renin and sPRR as biomarkers in human pregnancies. HRP‐Fc was tested in DOCA‐salt and RUPP rat models. Results : HRP‐Fc was tested in DOCA‐salt and RUPP rat models, showing significant benefits: DOCA‐salt model : HRP‐Fc reduced mean arterial pressure (MAP), proteinuria, and restored litter size. RUPP model : HRP‐Fc reduced MAP, normalized TNF‐α levels, decreased sFlt‐1 levels, and modulated immune cell profiles, alleviating maternal hemodynamic and inflammatory dysfunctions. Higher doses of HRP‐Fc were more effective. DOCA‐salt model : HRP‐Fc reduced mean arterial pressure (MAP), proteinuria, and restored litter size. RUPP model : HRP‐Fc reduced MAP, normalized TNF‐α levels, decreased sFlt‐1 levels, and modulated immune cell profiles, alleviating maternal hemodynamic and inflammatory dysfunctions. Higher doses of HRP‐Fc were more effective. In the human study, plasma (pro)renin and sPRR levels were measured in 76 pregnant women across four time points. Women who developed PreE had significantly higher levels of these biomarkers compared to those with normal pregnancies. In PreE patients, (pro)renin levels increased from 0.18 ± 0.01 µg/mL in the first trimester to 0.32 ± 0.02 µg/mL at delivery, while sPRR levels rose from 18 ± 2.7 µg/mL to 33 ± 6.8 µg/mL. In normal pregnancies, (pro)renin levels increased from 0.16 ± 0.01 µg/mL to 0.20 ± 0.01 µg/mL, and sPRR levels rose from 16 ± 4.5 µg/mL to 22 ± 6.5 µg/mL. Conclusion : Elevated (pro)renin and sPRR levels are promising biomarkers for PreE. HRP‐Fc demonstrated efficacy in reducing hypertension, proteinuria, inflammation, and angiogenic imbalance in rat models, highlighting its potential as a therapeutic agent.

Noura Sandouka 1 ; Amal Yosef 1 ; Rivka Farkash 1 ; Maskit Bar Meir 1 ; Sorina Grisaru‐Granovsky 1 ; Maayan Bas Lando 2 1 Shaare Zedek Medical Center, Jerusalem, Israel; 2 Hebrew University and Shaare Zedek Medical Center, Jerusalem, Israel Objective : To determine whether maternal bacteriuria during hospitalization for preterm premature rupture of membranes (PPROM) is associated with increased neonatal morbidity. Study Design : We performed a retrospective cohort study of singleton pregnancies complicated by PPROM, 24–34 weeks, at a tertiary medical center. Multifetal gestations, intrauterine fetal demise, and cases classified as contamination were excluded. Maternal urine cultures obtained during hospitalization were reviewed, and patients were classified according to the presence of any positive urine culture. The primary outcome was a composite neonatal adverse outcome defined as positive neonatal blood culture, intraventricular hemorrhage (grade III–IV), respiratory distress syndrome, necrotizing enterocolitis, neonatal death, 5‐minute Apgar 14 days. Multivariable logistic regression was performed adjusting for gestational age at delivery, latency from PPROM to delivery, group B streptococcus status, meconium, and mode of delivery. Results : A total of 794 pregnancies met inclusion criteria; 253 (31.9%) had positive maternal urine cultures. The composite neonatal adverse outcome occurred more frequently in the positive urine culture group compared with the negative group (67.2% vs 54.5%, p  < 0.001). After adjustment for gestational age, latency, GBS status, meconium, and cesarean delivery, maternal urine culture positivity remained an independent predictor of the composite neonatal adverse outcome (OR 2.0, 95% CI 1.2–3.4, p  = 0.007). Secondary analyses showed higher rates of prolonged NICU stay >14 days (59.1% vs 51.4%, p  = 0.037) and a trend toward higher rates of respiratory distress syndrome (21.7% vs 16.1%, p  = 0.053). Positive neonatal blood cultures occurred in 13.8% vs 8.7% ( p  = 0.26). Conclusion : Maternal bacteriuria during hospitalization for PPROM is independently associated with increased neonatal morbidity. Urine culture positivity may serve as an additional marker of intrauterine infection risk in pregnancies complicated by PPROM.

Atara De Porto 1 ; Vadim Sheiman 2 ; Elad Preuss 1 ; Gabriela Goldinfeld 2 ; Josef Tovbin 1 ; Eran Barzilay 1 1 Samson Assuta Ashdod Medical Center, Ashdod, Israel; 2 Samson Assuta Ashdod Medical Center, Ashdod Objective : To evaluate whether immediate postpartum transabdominal ultrasound can accurately predict histologically confirmed retained placenta in women undergoing manual uterine revision. Study Design : This prospective cohort study was conducted at a tertiary labor and delivery unit between November 2022 and June 2025. Women aged 18–45 years with term singleton vaginal delivery and clinical suspicion of retained placenta were included. All participants were scheduled for manual uterine revision. A standardized transabdominal ultrasound examination was performed 2–3 minutes prior to revision. Predefined sonographic parameters included echogenic intracavitary mass, intracavitary Doppler flow, uterine dimensions, calculated uterine volume, and endometrial thickness. Histologic evaluation of intrauterine material served as the reference standard. Results : A total of 100 women were recruited, of whom 93 had histologic data available for analysis. Retained placenta was confirmed in 37 women (39.8%). Women with retained placenta were slightly older (median 29 vs 28 years, p  = 0.047) and more likely to have a prior history of retained placenta (35.1% vs 16.1%, p  = 0.034). No other maternal or obstetric characteristics differed between groups. The presence of an echogenic intracavitary mass (54.1% vs 37.5%, p  = 0.116) and intracavitary Doppler flow (48.6% vs 35.7%, p  = 0.214) was more frequent among women with retained placenta but did not significantly differentiate between groups. Diagnostic performance was poor, with low sensitivity and specificity for both echogenic mass (54.1% and 62.5%) and Doppler flow (48.6% and 64.3%). Endometrial thickness showed no predictive value (AUC 0.50; 95% CI 0.38–0.62). Conclusion : Immediate postpartum ultrasound does not reliably predict retained placenta and should not be used to guide decisions regarding manual uterine revision.

Arya Aliabadi 1 ; Leonie van Rheenen 2 ; Nicholas Rubashkin 3 1 UCSF, San Francisco, CA; 2 OLVG, Amsterdam, Netherlands; 3 University of California, San Francisco, San Francisco, CA Objective : To assess obstetrics and gynecology physician trainee attitudes toward vaginal breech birth (VBB), prior breech exposure, and priorities for future simulation‐based training at two international tertiary healthcare systems. Study Design : We conducted an anonymous cross‐sectional online survey of residents at UCSF and OLVG in 2026 using 15 Likert‐scale statements (1 = strongly disagree to 5 = strongly agree) assessing values toward VBB, perceived preparedness, and future training priorities. Pre‐specified domains included values, preparedness, and simulation priorities. Comparisons by training site and prior breech exposure used Wilcoxon rank‐sum tests. A proportional‐odds model evaluated associations with preparedness adjusting for training level and site. Two‐sided p values <0.05 were considered significant. Results : Seventy one percent of trainees responded ( n  = 64). Most residents agreed that maintaining vaginal breech competency is important ( n  = 59, 92%) and supported formal simulation training ( n  = 61, 95%). Values scores were high (median 4.6, IQR 4.2–4.8) and simulation priority scores were high (median 4.7, IQR 4.3–4.8), while preparedness remained lower (median 2.3, IQR 1.5–3.3). Only 16% ( n  = 10) felt prepared to lead a planned VBB. Dutch trainees felt more prepared than their American counterparts (median 2.8, IQR 1.9–3.3 vs 1.8, IQR 1.5–2.8; p  = 0.02). Preparedness was also higher among residents with prior breech exposure (median 3.0, IQR 2.0–3.8 vs 1.8, IQR 1.3–2.5; p  < 0.001). In adjusted analysis, prior exposure remained independently associated with higher preparedness (aOR 2.66, 95% CI 1.04–6.82; p  = 0.04). Conclusion : Residents across two international training programs strongly support preservation of VBB competencies and expansion simulation‐based training, yet report limited preparedness. Higher Dutch preparedness likely reflects greater system‐level preservation of VBB training and prior clinical exposure, albeit confidence remained incomplete in both settings. These findings support a values‐informed, simulation‐based curriculum to support the post–Term Breech Trial “de‐skilling” generation.

Rachel K. Harrison 1 ; Michelly R. Vendette 2 ; Elizabeth Lemoine 3 ; Matthew Zuber 3 1 Advocate Christ Medical Center, Oak Lawn, IL; 2 Wake Forest University School of Medicine, Clemmons, NC; 3 Wake Forest University School of Medicine, Winston‐Salem, NC Objective : The objective of this study is to assess the cost distribution of patients undergoing cesarean hysterectomy with placenta accreta spectrum (PAS) using the National Inpatient Sample (NIS), HCUP‐AHRQ. The study tests the hypothesis that there are similar outcomes despite higher clinical resource utilization in the highest cost quartile (Interquartile Range 4 or IQR4) versus the lowest (IQR1). Study Design : This analysis utilized the NIS, a deidentified and publicly available dataset sampling of 20% of inpatient national records in the US from 2017–2021. We included those with International Classification of Disease codes for cesarean hysterectomy for PAS. Groups were separated and compared based on cost quartile. Baseline characteristics, clinical outcomes, a composite of Center of Disease Control Severe Maternal Morbidity (SMM), surgical complications, and other resource utilization were then compared among the four groups using ANOVA, Chi2 analysis, or Kruskal Wallis tests as indicated. Results : A total of 1972 patients were divided into four cost quartiles ( N  = 493 each), ranging from median ≤$47,523 (IQ1) to ≥$123,037 (IQ4). Severity of invasion increased with cost: percreta was present in 9.7% of IQ1 versus 31.5% of IQ4 ( p  < 0.001). Racial composition and hospital characteristics also differed significantly, with costlier surgical hospitalization more common among non‐white individuals and performed in private for‐profit hospitals. Nearly all morbidity metrics worsened with increasing cost: SMM rose from 38.7% to 51.3% and mean length of stay rose from 4.0 to 17.6 days (all p  < 0.001). IQ4 had significantly higher rates of DIC vs IQR1 (14.4% vs. 3.0%), ileus or bowel obstruction (8.1% vs 3.5%), urologic repair (22.3% vs. 6.3%), and surgical complications (41.2% vs 13.8%) (all p  < 0.05, Table). Blood transfusion rates did not differ. Conclusion : Higher‐cost cesarean hysterectomy for PAS was associated with more advanced placental invasion. SMM and surgical complications were more frequent in higher cost surgical hospital stays.

Rachel K. Harrison 1 ; Janki Amin 2 ; Nikola Koziol 2 ; Annie Dude 3 ; Calla Holmgren 1 ; Anna Palatnik 4 1 Advocate Christ Medical Center, Oak Lawn, IL; 2 Illinois Masonic Medical Center, Chicago, IL; 3 University of North Carolina at Chapel Hill, Chapel Hill, NC; 4 Medical College of Wisconsin, Milwaukee, WI Objective : We examined the association of several maternal factors on postpartum (PP) presentation for care in a cohort of patients with hypertensive disorders of pregnancy (HDP) at delivery. Study Design : Retrospective case‐control study evaluating risk factors for PP presentation to the hospital for HDP‐related symptoms among patients with HDP at delivery (January to June 2024). Those with chronic hypertension were excluded. Maternal demographics, furosemide administration, severe hypertension (defined as requiring IV antihypertensives), maternal length of stay, gestational age at delivery, and outpatient antihypertensive prescription were assessed. Those who were readmitted or presented to the emergency room (ER) in the PP period for an HDP‐related concern (high BP, vision changes, shortness of breath, swelling, or headache) were compared to those who did not via Chi‐squared, fisher's exact, and student t‐tests. Univariable and multivariable generalized linear regression models were used to assess the impact of each factor on the likelihood of readmission or presentation to the ER. Results : A total of 197 subjects met inclusion criteria. Of these, 23 (11.7%) were either readmitted ( N  = 8 (4.0%)) or seen in OB ER ( N  = 15 (7.6%)). Baseline characteristics were similar between groups including age, nulliparity, body mass index, race, ethnicity, and marital status. Severe hypertension and furosemide administration were similar in each group (33.9% vs 39.1%, p  = 0.621 and 20.8% vs 34.8%, p  = 0.131 in the non‐presenting vs presenting groups, respectively). The only significant difference between groups is that 73.9% of those who re‐presented for PP care were sent home on antihypertensive medications vs 16.1% of those who did not ( p  < 0.001). In the adjusted model, nulliparity and a PP antihypertensive medication prescription were associated with representation for HDP‐related complaints after initial discharge (Table). Conclusion : Presentation in the PP period for HDP‐related concerns is associated with nulliparity and use of antihypertensive medications postpartum. This may be due to worse baseline HDP diagnosis.

Rinat Gabbay‐Benziv 1 ; Esther Maor‐Sagie 1 ; Amos Stern 2 ; Inna Bleicher 3 ; Simon Shenhav 4 ; Enav Yefet 5 ; Yifat Wiener 6 ; Michal Kovo 7 ; Maya Frank Wolf 8 On behalf of the Division of Government Medical Centers at the Israeli Ministry of Health, and the Kinneret OMOP initiative (Grant No. 0007955) 1 Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel; 2 The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel; 3 Department of Obstetrics and Gynecology, Bnai‐Zion Medical Center, Haifa, Israel, Israel; 4 Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel; 5 Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel., Poriya, Israel., Israel; 6 Department of Obstetrics and Gynecology, Shamir Medical Center, Zerifin, Israel; 7 Faculty of Medicine, Hadassah‐Hebrew University, Jerusalem, Israel; 8 Raya Strauss Wing of Obstetrics and Gynecology, Galilee Medical Center; Azrieli Faculty of Medicine, Bar‐Ilan University, Nahariya, Israel Objective : Gestational diabetes mellitus (GDM) and multifetal gestation are each associated with adverse pregnancy outcomes. However, the effect of GDM in multifetal pregnancies remains unclear. We evaluated the associations between GDM and perinatal, neonatal, and long‐term offspring outcomes in multifetal compared with singleton pregnancies. Study Design : This national multicenter retrospective cohort study used harmonized electronic medical record data from six tertiary centers between 2010–2024. Pregnancies were categorized into four groups: singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM. Primary outcomes included neonatal complications (hypoglycemia, NICU admission, respiratory morbidity) and long‐term offspring neurological and ophthalmologic morbidity. Multivariable regression analyses adjusted for maternal age, body mass index, parity, fertility treatment, and gestational age for neonatal outcomes. Results : The cohort included 134,517 pregnancies resulting in 136,579 offspring. Of these, 90.6% were singleton without GDM, 7.9% singleton with GDM, 1.3% multifetal without GDM, and 0.2% multifetal with GDM. Multifetal pregnancies with and without GDM demonstrated similar neonatal outcomes. Among multifetal pregnancies, GDM was associated with lower odds of neonatal hypoglycemia (aOR 0.30; 95% CI 0.18–0.49), neurological morbidity (aOR 0.37; 95% CI 0.24–0.59), and ophthalmologic morbidity (aOR 0.49; 95% CI 0.31–0.77). In contrast, among singleton pregnancies, GDM was associated with higher rates of neonatal hypoglycemia, NICU admission, and neurological morbidity. Conclusion : In multifetal pregnancies, GDM was not associated with worsening neonatal outcomes. Unlike singleton pregnancies, multifetal GDM was associated with lower rates of neonatal hypoglycemia and long‐term neurological and ophthalmologic morbidity. These findings suggest that current GDM diagnostic and management approaches derived from singleton pregnancies may not fully reflect the risk profile of multifetal gestations.

Tewodros Getahun Asfaw 1 ; Ephrem G. Mamo 1 ; Birhanu Kebede Dina 1 ; Yared G. Tesfaye 2 On behalf of Y12HMC 1 Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia; 2 Yekatit 12 Hospital Medical College, Addis Ababa Objective : To assess maternal outcomes and patterns of termination of second and third trimester pregnancies due to fetal congenital Anomalies at Abebech Gobena MCH Hospital. Study Design : A facility based cross sectional study was conducted from July 1, 2025, to February 28, 2026, including 99 pregnant women. Data on sociodemographic characteristics, obstetric history, types of congenital anomalies, and maternal outcomes were collected using a structured questionnaire. Bivariate and multivariate logistic regression analyses were performed to identify predictors of maternal complications, with statistical significance set at p  < 0.05. Results : A total of 99 women underwent termination for fetal congenital anomalies. Central nervous system malformations were most common; mainly Chiari II malformation (37.4%) and acrania exencephaly anencephaly sequence (32.3%). Most were diagnosed in the second trimester (mean gestational age: 22.1 ± 6.8 weeks), while 26.3% were detected after 24 weeks. Among pregnancies ≥24 weeks, 84.6% underwent feticide using ultrasound guided intracardiac potassium chloride injection. No maternal deaths occurred. Most women (67.7%) had no complications; reported complications were minor, including retained products of conception (27.3%), anemia (8.1%), and sepsis (3%), all managed successfully. Notably, 89.9% had not used periconceptional folic acid. Termination before 24 weeks was significantly associated with higher odds of maternal complications (AOR = 5.21; 95% CI: 1.35–20.16). Conclusion : Pregnancy termination for fetal congenital anomalies, whether performed before viability or following feticide after 24 weeks, was generally safe and feasible in this low resource setting. However, termination before 24 weeks was associated with a higher risk of maternal complications. The low uptake of periconceptional folic acid highlights the need for strengthened preventive strategies to reduce neural tube defects and other congenital anomalies.

Emily Trygg 1 ; Sofia Pihl 2 ; Anna Ramö Isgren 3 ; Kristin Thomas 4 ; Marie Blomberg 5 1 Linköping University, Region Östergötland Sweden, Linköping, Sweden; 2 Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 3 Linköping University, Linköping, Sweden; 4 Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 5 Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden Objective : The World Health Organization introduced the Labour Care Guide (LCG) in 2020, a new documentation tool for monitoring active labour and promoting supportive care. While primarily evaluated in low‐ and middle‐income settings, data from high‐resource settings remains minimal. This study aimed to assess perceived usability and satisfaction of a Swedish digital version of the LCG (LCG‐SE) after 3 or 6 months of clinical use in labour wards participating in the PICRINO trial. Study Design : This cross‐sectional study was conducted within the stepped‐wedge cluster randomised PICRINO trial in Sweden, including healthcare professionals from participating 24 labour wards nationwide. Usability and satisfaction were assessed using a validated digital questionnaire, including the System Usability Scale (SUS) and section‐specific and overall satisfaction ratings. Data were analysed using descriptive and inferential statistics. Results : 614 respondents completed the questionnaire, yielding a response rate of 35%. The median SUS score was 52.5 (IQR 40–65), with 18% of respondents rating usability as “good” (SUS score ≥70). Satisfaction was low, with 15.3% of respondents expressing overall satisfaction with LCG‐SE. When stratified by labour ward size ( 2000 births/year), both SUS scores and satisfaction ratings (section‐specific and overall) were significantly higher in smaller wards. Physicians reported higher scores for both usability and satisfaction compared to midwives. No significant difference was observed between 3 and 6 months of use. Conclusion : LCG‐SE was associated with acceptable usability but low satisfaction in Swedish labour wards. The findings highlight challenges in implementing digital tools like LCG‐SE in high‐resource settings with existing, well‐integrated digital medical records. Perceived usability and satisfaction appear to be influenced by differences in professional roles and size of labour wards.

Else F. Segers 1 ; Mirthe Hendriks 2 ; Sofia Jileaeva 2 ; Polina Putrik 3 ; Adja Waelput 1 ; Loes Bertens 1 ; Bastian Ravesteijn 2 ; Eric A. P. Steegers 1 ; Hilmar H. Bijma 1 1 Erasmus Medical Center, Rotterdam, Netherlands; 2 Erasmus University, Rotterdam, Netherlands; 3 Maastricht University, Public Health Service South Limburg (GGD Zuid‐Limburg), Maastricht, Netherlands Objective : To develop and validate supervised machine learning models to predict preterm birth (PTB) and small‐for‐gestational‐age (SGA) at 16 weeks GA using nationwide socioeconomic and obstetric data. Study Design : We conducted a nationwide retrospective cohort study in singleton pregnancies using linked data from the Dutch perinatal registry (Perined) and Statistics Netherlands (2010–2020). We hypothesized that a random forest model using socioeconomic and obstetric data improves prediction compared with a history of PTB or SGA (reference approach). Analyses were stratified by parity. For reference in primiparous women, we matched sensitivity to multiparous women using random assignment. Performance was evaluated using sensitivity, proportion classified as high‐risk, positive predictive value (PPV), and specificity. Results : Among 1,449,083 singleton births, 4.9% were PTB and 10.3% SGA. For PTB, in multiparous women, a reference approach using history of PTB classified 8.3% as high‐risk (sensitivity 33.5%, specificity 92.7%, PPV 14.8%; Table 1). At equal sensitivity, the model classified 8.3% as high‐risk, with similar specificity 92.6% and a PPV of 14.7%. In primiparous women, the model classified fewer women as high‐risk (28.0%, specificity 72.4%, PPV 7.5%) compared to the reference (33.5% high‐risk, specificity 66.5%, PPV 6.3%). For SGA, in multiparous women history of SGA classified 15.7% as high‐risk (sensitivity 50.1%, specificity 87.0%, PPV 23.1%). At equal sensitivity, the model classified 15.8% as high risk, with similar specificity 86.9% and PPV 22.9%. In primiparous women, the model classified fewer women as high‐risk (40.4%, specificity 61.2%, PPV 16.9%) compared to the reference (50.1% high‐risk, specificity 49.9%, PPV 13.6%). Conclusion : Machine learning models using socioeconomic and obstetric data add value for predicting PTB and SGA primarily in primiparous women, whereas in multiparous women, prediction did not improve.

Miguel A. Bonilla Moreno 1 ; Michael Sussman 1 ; Mia Ramirez 1 ; William Runion 1 ; Adair Boudreaux 2 ; Mallory Crouch 1 ; David May 2 ; Addison Stone 2 ; Anna Larussa 2 ; Impana Murthy 2 ; Celeste E. Levy 2 ; Grace Gutierrez 2 ; Chi P. Dola 2 1 Tulane University School of Medicine, Department of Obstetrics and Gynecology, New Orleans, LA; 2 Tulane University School of Medicine, New Orleans, LA Objective : To identify antenatal and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy (HIE) using the requirement for neonatal therapeutic hypothermia as a clinical surrogate. Study Design : This retrospective case‐control study analyzed neonates delivered at a single New Orleans institution between February 2014 and August 2024. Twenty‐five singleton neonates (> 36 weeks' gestation) who underwent therapeutic hypothermia (Group I) were matched 1 to 2 by gestational age with a control group of non‐cooled neonates (Group II). Maternal demographics, antenatal and intrapartum characteristics, and neonatal outcomes were compared with Student’ t‐test and Chi‐square analyses, with p  < 0.05 considered significant. Results : No significant difference was found in maternal age, BMI, gestational weight gain, or race between Group I and II. Significant difference in Intrapartum factors were noted in Group I versus Group II, including anti‐hypertensive medication use in pregnancy (20% vs 2%), moderate to heavy meconium (20% vs 2%), labor induction (66.7% vs 38%), misoprostol use (36% vs 10%), placental abruption (16% vs 10%), failure to descend (28% vs 0%), and emergent cesarean delivery for non‐reassuring fetal tracing (58% vs 8%) were noted between the two groups, p  < 0.05. Scheduled cesarean deliveries (0% vs 16%) and spontaneous vaginal deliveries (32% vs 62%) were less likely in Group I, p  < 0.05. There was a statistically significant difference in APGAR score at 1 (1.6 ± 1 vs 8.1 ± 1.3) and 5 minutes (4.1 ± 1.7 vs 8.8 ± 0.5), cord pH (7.0 ± 0.2 vs 7.3 ± 0.1), base excess (12.6 ± 6.0 vs 2.3 ± 2.2), neonatal hemoglobin (15.8 ± 2.2 vs and hematocrit (47.7 ± 6.9 vs 32.4 ± 5.8), p  < 0.05. Conclusion : While major obstetric catastrophes are known triggers for HIE in neonates, this study highlights that common antenatal and intrapartum factors also carry significant risk. Recognizing these predictors may allow clinical interventions to reduce adverse neonatal outcomes. Additional studies are required to establish use of these findings to guide clinical management during pregnancy and labor.

Haylea Sweat Patrick 1 ; Alison D. Caceres 2 1 Jersey City Medical Center, Jersey City, NJ; 2 Rutgers Jersey City Medical Center, Jersey City, NJ Objective : Iron deficiency anemia (IDA) in pregnancy is associated with adverse maternal and perinatal outcomes. Standard repletion of Intravenous (IV) usually necessitates coordinated outpatient follow‐up for treatment completion. At our institution, IV iron is frequently initiated in the labor and delivery (L&D) triage setting; however, outpatient follow‐up is not standardized. We evaluated whether patients receiving IV iron in triage complete recommended therapy and undergo appropriate diagnostic evaluation. Study Design : We conducted a retrospective cohort study of all IV iron administrations in a single‐institution L&D triage in the calendar year 2025 using electronic medical records. Data collected included gestational age (GA) and hemoglobin at time of administration, prior IDA diagnosis, iron studies prior to infusion, completion of full IV iron regimen prior to delivery, and hemoglobin and GA at delivery. Descriptive statistics were performed to summarize key characteristics in data and provide insights into underlying patterns and trends. Results : A total of 40 IV iron administrations were identified. 13 (32.5%) patients had a pre‐existing diagnosis of IDA, and iron studies were obtained in 4 cases (10%); of which 2 were consistent with IDA. Only 3 patients (7.5%) completed the full IV iron regimen prior to delivery. Patients who completed therapy had higher mean hemoglobin at delivery compared with those who did not (12.9 vs 9.8 g/dL). Conclusion : This baseline assessment demonstrates inconsistent diagnostic evaluation and poor completion of IV iron therapy when initiated in our L&D triage, highlighting a critical gap in transition to outpatient care. We hypothesize that standardized protocols to integrate diagnostic workup in triage with coordinated outpatient infusion scheduling will improve treatment completion and hematologic outcomes while reducing unnecessary utilization. Using triage‐based diagnostic evaluation, EHR‐guided order sets, and automatic outpatient infusion referral with scheduled follow‐up prior to discharge is underway to improve treatment completion and hematologic outcomes.

Lauren V. Cue 1 ; Alison D. Caceres 2 ; Barak Rosenn 1 1 Jersey City Medical Center, Jersey City, NJ; 2 Rutgers Jersey City Medical Center, Jersey City, NJ Objective : This study aims to describe our experience with outcomes of rescue cerclage placed in midtrimester. Study Design : This is an IRB approved retrospective cohort study of singleton pregnancies at Jersey City Medical Center between 2020–2024. Subjects had a rescue cerclage placed between 16–25 weeks of pregnancy following an ultrasound finding of a short cervix. Data collected for each patient included: maternal age, BMI, obstetric history, gestational age at placement, shortest cervical length measured by TVUS, cervical dilation at the time of placement, presence or absence of bulging membranes and use of balloon to displace bulging membranes. All cerclages were placed using #1 Proline, McDonald's technique, single loop, given Indomethacin and Cefazolin pre‐procedurally. Results : Our cohort involved a total of 57 patients, 35 of whom did not have a history of preterm delivery, 22 who did. Gestational ages at placement ranged widely between 16 weeks and 24 weeks and 5 days. Cervical lengths at the time of cerclage placement ranged between 0 and 24 mm, with the most cerclages placed between 5–10 mm. Of those with an extremely short cervix of 0–5 mm, most of them, (8/13) had bulging membranes and required posterior displacement with a balloon during cerclage placement. The cohort as a whole delivered at a median of 38 weeks. From 30–36 weeks, women with a history of preterm delivery showed a greater tendency toward earlier delivery. After week 37, the difference between the two groups became smaller. The chance of preterm delivery with bulging membranes was higher than in its absence, as 50% delivered before 34 weeks. Conclusion : Overall, most women who underwent mid‐trimester ultrasound indicated rescue cerclage had a good pregnancy outcome, and delivered at a median of 38 weeks. 81% of women remained pregnant at 34 weeks and 72% of women remained pregnant at 36 weeks. Even when a balloon was needed to displace membranes in the setting of bulging membranes and an extremely short cervix, the median gestational age at delivery was 33 weeks.

Elizabeth K. Wagman 1 ; Nicolette Ani Pirjanian 2 ; Martha A. Tesfalul 3 ; Frank B. Williams 4 ; Sarah Araji 5 ; Abdulfetah Abdulkadir Abdosh 6 ; Ukachi N. Emeruwa 7 ; Anju Ranjit 8 ; Felagot Taddese Taddese 6 ; Jessica S. Chung 9 ; Lauren A. Plante 10 ; Sarah Boudova 2 1 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 2 University of Illinois Chicago, Chicago, IL; 3 UCSF, San Francisco, CA; 4 Ochsner Health, Ochsner Health, LA; 5 Baylor College of Medicine, Houston, TX; 6 St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia; 7 University of California San Diego, San Diego, CA; 8 University of California, San Francisco, San Francisco, CA; 9 Medical College of Wisconsin, Milwaukee, WI; 10 Penn State College of Medicine, Hershey, PA Objective : Global health experiences during medical education can enhance knowledge, clinical skills, and cultural competency. However, formalized training opportunities at the level of maternal fetal medicine (MFM) fellowship are not well characterized. We aimed to assess global health opportunities, as well as perceived benefits and barriers, in United States MFM programs. Study Design : We conducted an IRB‐exempt cross‐sectional survey of Program Directors (PDs) of American College of Graduate Medical Education‐accredited MFM programs (January‐March 2026). PDs were identified through the SMFM fellowship program directory and invited by email to complete a REDCap survey. Duplicate responses were excluded and descriptive statistics were performed. Primary outcome was proportion of programs offering global health opportunities. Results : The survey had a 56% (62/111) response rate. Forty‐nine (79%) programs offer any global health training, most commonly by supporting outside opportunities (Figure 1). Among those, 11 (18%) provide funding, and allow fellows an average of 8 weeks (ranging from 1–52) dedicated to global health. Seven (11%) have a global health elective, consisting of clinical ( n  = 6) and teaching ( n  = 4) opportunities, structured travel ( n  = 3), and funding ( n  = 3). Among programs without electives, key barriers include lack of funding ( n  = 37, 60%), faculty mentorship ( n  = 29, 47%), and international partners ( n  = 22, 35%). Twenty‐five (45%) intend to offer a global health elective. Among all PDs, fifty‐one (82%) stated it was at least somewhat important to include global health in training (Figure 2A), with cultural awareness ( n  = 48) cited as the primary benefit (Figure 2B). While thirty‐nine (63%) of PDs report fellow interest global health clinical, teaching, or research training, only 37% ( n  = 23) feel current opportunities meet fellow needs. Conclusion : Most MFM PDs view global health as an important fellowship opportunity, but resource constraints inhibit formalized electives. SMFM‐supported didactics & collaborations may overcome barriers & enhance training.

Dagmar Hiensch 1 ; Niki van Elst 1 ; Caroline Dibbets 1 ; Misha Hussain 1 ; Emmely Wagener 1 ; Henwig van Hove 1 ; Lianne Van Bussel 1 ; Vera Bukkems 1 ; Rick Greupink 1 ; Liesbeth Scheepers 2 ; Saskia de Wildt 1 1 Radboud University Medical Center, Nijmegen, Netherlands; 2 MUMC+, Maastricht, Netherlands Objective : Evidence‐based dosing recommendations for pregnant individuals and children are often lacking, leading to uncertainty in clinical decision‐making and an increased risk of suboptimal treatment and adverse effects. Physiologically based pharmacokinetic (PBPK) modeling offers a promising approach to predict drug exposure by incorporating pregnancy‐ or age‐related physiological changes. Project Madam aims to develop model‐informed dosing recommendations for pregnant women and children and to implement these recommendations in clinical practice. Study Design : We integrated data on drug safety, efficacy, and pharmacokinetics to develop dosing recommendations for pregnant and pediatric populations. PBPK models were developed to support dose selection. Proposed recommendations were reviewed by a national multidisciplinary expert committee and, following a positive benefit–risk assessment, incorporated into national clinical guidelines. To facilitate implementation, we launched a website, delivered hands‐on workshops, and piloted a free self‐study module. Results : We developed PBPK models for ten medications in pregnancy, resulting in fourteen antenatal dosing recommendations adopted by the Dutch Teratology Information Service and the Dutch national drug formulary. In pediatrics, PBPK analyses for nine medications were incorporated as supportive evidence for dosing recommendations in the Dutch Pediatric Formulary. Educational activities have been delivered globally, both online and in person. Conclusion : Project Madam has succeeded in establishing and implementing dosing recommendations in pregnant and pediatric populations in Dutch clinical practice. Through awareness‐raising and education, Project Madam contributes to safer and more effective medication use, as well as to greater equity in pharmacotherapy.

Dagmar Hiensch 1 ; Caroline Dibbets 1 ; Vera Bukkems 1 ; Liesbeth Scheepers 2 ; Saskia de Wildt 1 On behalf of Project Madam Expert Group 1 Radboud University Medical Center, Nijmegen, Netherlands; 2 MUMC+, Maastricht, Netherlands Objective : Labetalol, metoprolol and nifedipine are frequently used antihypertensives during pregnancy. Dosing guidelines often recommend equal or lower doses than those for non‐pregnant individuals. However, pregnancy‐related physiological changes may alter drug exposure and compromise therapeutic effectiveness. We aimed to determine pregnancy‐specific dosing recommendations using a literature review, physiologically based pharmacokinetic (PBPK) modeling, and expert consensus. Study Design : Safety, efficacy, and pharmacokinetic data on the use of these antihypertensives during pregnancy were collected from literature and used to propose antenatal dosing regimens for labetalol, metoprolol and nifedipine using our previously developed Framework for Dose Selection in Pregnancy (FDSP). The proposal was reviewed by the multidisciplinary expert group and a consensus‐based dose was established. Results : Plasma levels of labetalol, metoprolol and nifedipine decrease substantially during pregnancy. For labetalol, increasing the starting dose from 100 mg every 12 hours to 100 mg every 8 hours is recommended. For metoprolol, dose titration based on clinical effect is recommended during the second and third trimester. Adequate maternal blood pressure control outweighs potential fetal and neonatal risks of beta‐blocker dose escalation. For nifedipine, it is recommended to increase the maximum daily dose from 90 mg to 120 mg, aligning with non‐pregnant patients. In very severe maternal hypertensive disorders at early gestational age and only in clinical settings, doses up to 240 mg can be considered. These dosing recommendations have been endorsed by the expert group and were incorporated into Dutch clinical practice. Conclusion : These evidence reviews underscore the risk of underdosing antihypertensives during pregnancy and the need for dose adjustments to ensure effective and safe treatment for mother and fetus.

Rebecca L. Anderson 1 ; Niranjana Balu 2 ; Logan Schroeder Schroeder 1 ; Alex Regan 1 ; Brittany Beaudrie 1 ; Madison Burgard 1 ; Alex Hergenrader 1 ; Joshua Dahlke 3 1 University of Nebraska Medical Center ‐ Omaha, NE, Omaha, NE; 2 University of Nebraska Medical University (UNMC) ‐ Omaha, NE ‐ 4111 Dewey AveOmahaOmaha, NE 68198UNITED STATES ‐ Omaha, NE, Omaha, NE; 3 Nebraska Methodist Hospital and Perinatal Center, Department of Maternal‐Fetal Medicine, Omaha, NE Objective : Variation in cesarean delivery (CD) technique exists due to surgeon preference and clinical factors. A standardized surgical technique has been proposed with the aim to improve efficiency and outcomes. Given that approximately one‐third of reproductive‐aged women have body mass index (BMI) 31–40 and a smaller but growing proportion (2–10%) have BMI > 40, we evaluated variation in CD technique at a tertiary care center by comparing observed practice and concordance to a standardized protocol by BMI. Study Design : CDs performed by credentialed obstetric providers at Methodist Women's Hospital in Omaha, Nebraska were prospectively observed over 6 months to document operative technique. Observed practices were compared with the proposed standardized protocol across BMI categories of BMI 31–40 and BMI > 40 using two‐proportion tests. Results : Of 874 CDs performed over a 6‐month period, 159 were observed (18%). BMI stratification included 70 cases with BMI 31–40 and 37 cases with BMI >40. When observed, statistically significant differences between BMI groups included fewer negative‐pressure wound dressings omission ( p  = 0.02), single layer uterine closure (0.01), increased closure of subcutaneous tissue ( p  = 0.04) and skin closure with monofilament ( p  = 0.04) in those with BMI > 40. (Table 1) Greater than >80% concordance with all surgical techniques with the standardized protocol were observed, except for blunt needle use, omission of barrier retractors, omission of intrauterine wiping, uterine exteriorization, omission of fascial dissection, subcutaneous closure ≥2 cm, and skin closure with monofilament. (Figure 1). Conclusion : In patients with obesity, variation in observed operative technique in 26 of 30 surgical techniques. Major differences were observed from the standardized protocol in use of barrier retractors, uterine exteriorization, and skin closure techniques. These findings support further consideration for BMI‐specific surgical techniques to optimize strategies to improve consistency and outcomes.

Rebecca L. Anderson 1 ; Alex Regan 1 ; Brittany Beaudrie 1 ; Niranjana Balu 2 ; Madison Burgard 1 ; Logan Schroeder Schroeder 1 ; Joshua Dahlke 3 ; Alex Hergenrader 1 1 University of Nebraska Medical Center ‐ Omaha, NE, Omaha, NE; 2 University of Nebraska Medical University (UNMC) ‐ Omaha, NE ‐ 4111 Dewey AveOmahaOmaha, NE 68198UNITED STATES ‐ Omaha, NE, Omaha, NE; 3 Nebraska Methodist Hospital and Perinatal Center, Department of Maternal‐Fetal Medicine, Omaha, NE Objective : Cesarean delivery (CD) is the most common surgical procedure performed worldwide. While there is evidence supporting specific operative techniques, variation in practice persists. A standardized CD protocol has previously been proposed, and we sought to evaluate variation in CD technique at a tertiary care center by comparing it to surgeons' preferences and observed operative practice. Study Design : Credentialed obstetric providers were surveyed at Methodist Women's Hospital in Omaha, Nebraska, regarding preferred CD techniques using a 5‐point Likert scale. CDs were then prospectively observed over 6 months to document operative technique. Observed practices were compared with surgeon preference and the proposed standardized protocol using two‐proportion tests. Results : Forty‐six of 49 obstetricians completed the survey (94%). A total of 159 CDs were observed among 874 performed (18%). Based on the survey, techniques with <80% agreement compared to a standardized approach included omission of fascia sharp dissection (46%), blunt needle use (30%), standardized wound dressing (30%), omission of barrier retractors (4%), uterine exteriorization (20%), omission of intrauterine wiping (15%), and omission of negative pressure wound dressing (39%) (see Table 1). In contrast, observed practice demonstrated >80% concordance with all surgical techniques, with the exception of blunt needle use (5%), omission of barrier retractors (35%), omission of intrauterine wiping (31%), uterine exteriorization (38%), omission of fascial dissection (64%), subcutaneous closure ≥2 cm (72%), and skin closure with monofilament (59%) (see Figure 1). Conclusion : Of the 30 surgical techniques surveyed, differences in preferences exist, however when observed, surgical technique is more consistent with a standardized approach. Major differences were observed in use of barrier retractors, uterine exteriorization and skin closure. These findings highlight areas of heterogeneity in preferred and observed CD techniques and identify targets for future quality improvement and surgical standardization.

Shanny Kolp‐Asis 1 ; Karin Edut 2 ; Oz Gavish 2 ; Ariel Lasry 2 ; Ariel Statman 2 ; Mariia Bun 2 1 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv; 2 Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel Objective : To evaluate the association between fetal growth restriction severity and 5‐minute Apgar scores in preterm singleton deliveries undergoing a trial of labor. Study Design : We conducted a retrospective cohort study of 2742 preterm singleton deliveries at a single tertiary medical center. Only women without a prior cesarean delivery who attempted vaginal delivery were included. Neonates were categorized by birthweight percentile into three groups: ≤3rd percentile, 3rd–10th percentile, and >10th percentile (reference). The primary outcome was 5‐minute Apgar score analyzed as a continuous variable. Multivariable linear regression was performed adjusting for maternal age, parity, gestational age at delivery (days), birthweight, and mode of labor onset (spontaneous, prostaglandins, balloon, oxytocin). Results : Gestational age at delivery was the strongest predictor of Apgar score (B = 0.028 per day, p  < .001). Severe SGA (≤3rd percentile) was independently associated with lower Apgar scores compared with appropriately grown neonates (B = −0.323, 95% CI −0.531 to −0.115; p  = 0.002). In contrast, moderate SGA (3rd–10th percentile) was not associated with Apgar score ( p  = 0.683). Mode of labor onset was not associated with Apgar score overall ( p  = 0.156), although oxytocin induction was associated with slightly lower Apgar scores compared with spontaneous labor in pairwise analysis ( p  = 0.028). Maternal age and parity were not significant predictors. Conclusion : In preterm singleton deliveries undergoing trial of labor, only severe SGA (≤3rd percentile), but not moderate SGA, is associated with lower Apgar scores. Gestational age remains the dominant determinant of neonatal condition at birth. These findings highlight the importance of distinguishing between degrees of fetal growth restriction when assessing peripartum risk.

Tamara Levy 1 ; Liat Mor 2 ; Ilia Kleiner 2 ; Noa Gonen 2 ; Eran Weiner 2 ; Yael Ganor Paz 2 1 Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; 2 Edith Wolfson Medical Center, Holon, Israel Objective : To evaluate key topics discussed in a novel structured feedback system for OBGYN residents performing cesarean sections. Study Design : In our OBGYN department a structured feedback system was implemented following elective cesarean sections based on Ottawa surgical competency operating room evaluation. Feedback is given orally by specialists to residents immediately post procedure and digitally summarized. All feedback forms were reviewed and analyzed. Results : 716 feedbacks over 3 years from 39 residents in various years of their residency were analysed. Manual technique and respect for tissue were discussed in 76.4%, operative stages and complication prevention in 71.1%, instrument handling and spatial orientation in 51.7%. Intraoperative monitoring and decision‐making were discussed in 84.1%, preoperative information gathering in 48.8% and proactive planning for complications in 37.8%. Teamwork was discussed in 20.3%, patient and family communication in 36.6%, and postoperative plan formulation in 35.7%. Conclusion : Feedback following Cesarean Sections predominantly emphasized procedural knowledge, technical skill development and intraoperative decision‐making. In contrast, non‐technical competencies were addressed less consistently. These findings suggest that even within a structured framework, feedback lacks non‐technical domains, although research demonstrates that structured feedback on these competencies can significantly improve resident performance. Faculty development may help promote non technical competencies among OBGYN residents.

Jasmine X. Kiley 1 ; Emma Mitchell‐Sparke 2 ; Frances Cates 3 ; Rebecca M. Reynolds 4 ; Edward Mullins 5 ; Catherine Aiken 3 1 University of Cambridge, Melbourne, FL; 2 Tufts University, Boston, MA; 3 University of Cambridge, Cambridge, United Kingdom; 4 University of Edinburgh, Edinburgh, United Kingdom; 5 Imperial College London, London, United Kingdom Objective : Pregnancy outcomes may be improved by optimizing preconception health; however, designing preconception research studies presents distinct challenges. These include estimating feasible recruitment, attrition, and expected pregnancy rates. We systematically reviewed existing preconception studies to quantify recruitment rates, retention, and pregnancies to inform feasibility assessments and sample size calculations for future preconception and pregnancy‐related research. Study Design : 12 databases were searched for studies reporting recruitment of non‐pregnant women intending to conceive into studies reporting at least one pregnancy outcome. Risk of bias and quality assessment were performed using the Newcastle‐Ottawa Scale and Cochrane RoB2, followed by GRADE. Statistical analysis was performed in R v4.4.1. Results : 79 studies ( n  = 117,603 participants; n  = 53,838 pregnancies) were included. Recruitment via healthcare settings yielded higher weekly recruitment (9 participants, IQR 4–19) compared with studies using only non‐healthcare‐based recruitment methods (2, IQR 2–4; p  < 0.001; Fig 1A). Weekly recruitment was higher in larger studies ( p  < 0.001, R 2  = 0.81; Fig 1B) and in LMICs compared to high‐income countries ( p  = 0.006). Attrition prior to conception was lower in observational than interventional studies ( p  = 0.02) and among those with fertility issues compared to those with other medical comorbidities ( p  = 0.005). Among participants who conceived, retention during pregnancy was high across all studies (97.7%, IQR 95.2–99.0), with higher retention in interventional than observational studies ( p  = 0.002; Fig 2). Conclusion : Participant characteristics, recruitment strategy, and study design have important implications for feasibility assessment, anticipated loss to follow‐up, and sample size estimation. This study highlights the need for recruitment of diverse populations and methodological tools tailored to preconception research. These findings offer empirically grounded parameters to support the design of more efficient, inclusive, and adequately powered preconception and pregnancy‐related studies.

Grace Mealy 1 ; Sophie Callanan 2 ; Patrick J. Twomey 3 ; Mark T. Kilbane 4 ; Alexander P. Douglass 5 ; Fionnuala M. M. McAuliffe 6 1 UCD Perinatal Research Centre, School of Medicine, University College Dublin; The National Maternity Hospital, Dublin, Ireland; 2 UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, Dublin, Ireland; 3 St Vincent's University Hospital; University College Dublin, Dublin, Ireland; 4 Department of Clinical Chemistry, St Vincent's University Hospital, Dublin, Ireland; 5 School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; 6 University College Dublin, Dublin, Ireland Objective : Menopause is associated with a decrease in bone mass; however, early identification may reduce the extent of decline. Levels of chronic inflammation may impair bone health but the relationship between detailed immune profiling and bone parameters in women during the late reproductive years requires further exploration. This study examined whether immune markers were associated with bone health 10 years after pregnancy. Study Design : This analysis included 302 women from the ROLO longitudinal birth cohort at 10 years postpartum. Bone health was assessed via DXA scans. Blood samples were obtained to measure serum markers of bone turnover (TP1NP, CTX1) and immune function. Participants were dichotomised at the median immune marker level, and differences in bone health were evaluated. Significant associations were further examined to adjust for demographic factors, including BMI. Results : Participants ranged from 33.3–51.5 years, 61.6% were living with overweight/obesity, and 99.0% were Caucasian. Initial analyses showed positive associations between leptin, C‐reactive protein, lymphocytes, and monocytes with bone mineral density (BMD), T‐scores, and gynoid bone mass. There were negative associations between glycoprotein acetyls, eosinophils, and basophils with bone turnover markers. After adjustment, basophil count remained negatively associated with CTX1 (B = –3.785; p  = 0.024) and monocyte count remained negatively associated with total T‐scores (B = –0.010; p  = 0.039). Conclusion : Immune markers are associated with bone health in women of late reproductive age. Several associations were attenuated after adjusting for demographic factors, including BMI. Routine immune measures may provide a low‐cost, accessible means of providing insight into bone health status.

Valentina Romagnoli 1 ; Elisa Sabattini 2 ; Ottavio Cassardo 3 ; Ilaria Pozzi 1 ; Francesca Maria Paola M. P. Gigli 4 ; Simona Russo 1 ; Michele Orsi 3 ; Giuseppe Perugino 5 ; Francesca Parisi 5 ; Irene Cetin 5 1 Università degli Studi di Milano, Milano, Italy; 2 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 3 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy; 4 Università degli Studi Di Milano, Milano, Italy; 5 S.C Ostetricia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy Objective : To identify modifiable risk factors for intraoperative bleeding in placenta previa in a high‐volume tertiary referral center. Study Design : etrospective study conducted at the Obstetrics Unit of IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, between January 2020 and December 2024. Eligible participants were women with placenta previa or low‐lying placenta undergoing elective cesarean delivery. Cesarean delivery was scheduled at 36 0 –36 6 weeks for anterior placenta previa and at 37 0 –37 6 weeks for posterior or low‐lying placenta; earlier delivery was performed when indicated. Data were extracted from electronic records. Multivariable logistic and linear regression analyses evaluated risk factors for intraoperative blood loss. Results : Among 28,763 deliveries, 353 cases of placenta previa were identified (1.01%). Median maternal age was 36.8 years; 37% were nulligravida, 23.5% had a prior cesarean delivery, and 29% conceived with ART. Placenta previa accounted for 45.6% and low‐lying placenta for 54.4%. Nineteen hysterectomies occurred. Maternal characteristics were not associated with intraoperative hemorrhage >1000 mL. Significant predictors included >1 prior cesarean delivery (OR 4.09), suspected placenta accreta spectrum (OR 5.01), central (OR 3.22) and anterior placenta previa (OR 3.77). Intraoperative factors associated with hemorrhage were general anesthesia (OR 3.02), longitudinal incision (OR 6.46), manual placental removal (OR 4.35), and uterine exteriorization (OR 1.76). At multivariable linear regression analysis, only preoperative hemoglobin (β −0.101; p  = 0.010) and central placenta previa (β + 0.247; p  = 0.017) remained independently associated with blood loss. Conclusion : In placenta previa, intraoperative bleeding appears driven by placental characteristics and intraoperative factors rather than baseline maternal features. Central and anterior placenta previa, previous cesarean delivery, suspected placenta accreta spectrum, and general anesthesia were associated with increased hemorrhage risk, whereas higher preoperative hemoglobin was protective.

Nabia Kheshtchin‐Kamel 1 ; Andrea Vazquez 2 ; Jessica Guido 2 ; Gurkaran Singh 2 ; Terese Kulangara 2 ; Natasha Gill 2 ; Hannah Petree 3 ; Hannah Krisch 2 ; Jasmine Marshall 2 ; Shaun Brennan 2 ; Robert W. Bina 2 1 University of Arizona, College of Medicine ‐ Phoenix, Tempe, AZ; 2 University of Arizona, College of Medicine ‐ Phoenix, Phoenix, AZ; 3 Florida State University, Phoenix, AZ Objective : Stroke is a major contributor to maternal morbidity and mortality. Pregnancy‐related changes increase risk (venous stasis, hypercoagulability). Incidence is ∼30 per 100,000 deliveries and rising. The objective is to analyze demographics, risk factors (RFs), and outcomes to define patterns and management needs. Study Design : Studies included case series, case reports, and retrospective cohorts reporting stroke events in pregnant patients from inception to July 1, 2024. Studies excluded were those without any reported patient age, RFs, or outcomes. Demographics were extracted (age, race, insurance status), RFs (hypertension, preeclampsia, tobacco use, etc.), stroke types, timing within pregnancy, and maternal and fetal outcomes. Results : A total of 1238 patients, ages 15–45, were included. RFs were reported in 868 patients. Strokes reported, total 392, were intracerebral hemorrhage (86%), ischemic (7.6%), subarachnoid hemorrhage (2.0%), and other types (∼4.4%). The predominantly reported racial groups were: White (38.4%), Latin/Hispanic (34.0%), and Black (19.9%), with “Other” (4.3%) and Asian (3.3%) following. Insurance coverage reported predominantly as: private/other (59.7%), Medicaid (31.7%), self‐pay (6.6%) and Medicare (2.0%). The leading RFs were: pre‐eclampsia (27.5%), tobacco use (20.8%), and hypertension (16.7%). Most strokes occurred in an unspecified trimester (77.5%). Maternal mortalities were 81% of total 100 mortalities. Maternal neurological deficits, 122 total, included seizures (36.9%), abnormal neurological exams (18.9%), and increased deep tendon reflexes (7.4%). Fetal complications, 12 total, included miscarriage (58.3%) and necessitated C‐sections (25%). Conclusion : Cerebrovascular complications in pregnancy are a major cause of maternal morbidity and mortality. Hypertension, preeclampsia, and tobacco use emerged as key risk factors. High adverse outcome rates support earlier diagnosis, prevention, and multidisciplinary care. Inconsistent event‐timing data highlights the need for standardized prospective research.

Hélène F. C. van Oorschot 1 ; Rebecca Vellekoop‐ van Ravenswaaij 2 ; Eline W. Bel 1 ; Cornelis T. B. Ahaus 3 ; Ester del Barco 4 ; Evelien S. van Hoorn 3 ; Petra J. Porte 3 ; Arie Franx 2 ; Anke Posthumus 2 ; Martine Depmann 1 ; Nerea Maiz 4 ; Olof Stephansson 5 ; Mireille N. Bekker 1 1 Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands; 2 Department of Obstetrics & Gynaecology, Erasmus MC Sophia Children's Hospital, Rotterdam, Rotterdam, Netherlands; 3 Health Services Management & Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands; 4 Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; 5 Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden Objective : Telemonitoring is a promising response to global healthcare challenges. In high‐risk pregnancy care, remote cardiotocography (CTG) monitoring has been shown to reduce hospital‐based care while maintaining safety, improving patient experience, and reducing costs; however, implementation remains scarce. Insights into implementation challenges, particularly during the pre‐implementation phase and across international settings, remain limited. This study, conducted by the PregnaDigit‐EU consortium, aimed to identify pre‐implementation facilitators and barriers to telemonitoring, find scalable strategies, and examine shared and setting‐specific factors across international healthcare settings. Study Design : This qualitative pre‐implementation study employed semi‐structured interviews based on the Consolidated Framework for Implementation Research (CFIR) with obstetric healthcare providers at Karolinska University Hospital (Stockholm, Sweden) and Vall d'Hebron University Hospital (Barcelona, Spain). Results : Data saturation was reached after 15 interviews. Facilitators and barriers clustered across four themes: target population, readiness for implementation, safety, and patient impact (Figure 1). Patient eligibility for telemonitoring was shaped by medical, personal, and socioeconomic factors. While telemonitoring was considered feasible and promising, readiness was constrained by workload concerns and limited staff involvement and knowledge. Clear protocols and trained staff acted as facilitators when available and barriers when absent. Safety concerns focused on home emergencies and reduced personal connection, with setting‐specific differences in safety risk mechanisms and technical reliability. Conclusion : This cross‐border pre‐implementation study highlights the need for local due diligence and targeted training early in implementation, as setting‐specific factors require tailored strategies to support successful, scalable implementation across healthcare settings.

Afshan B. Hameed 1 ; Diana S. Wolfe 2 ; Katelyn Black 3 ; Jenny Chang 4 ; Heike Thiel de Bocanegra 1 1 University of California, Irvine, School of Medicine, Department of Obstetrics and Gynecology, Orange, CA; 2 Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; 3 University of California, Irvine School of Medicine, Department of Obstetrics and Gynecology, Orange, CA; 4 University of California, Irvine School of Medicine, Orange, CA Objective :  To evaluate the predictive value and alternative versions of the CVD risk assessment algorithm to support universal CVD risk assessment in pregnancy and the postpartum period. Study Design : We conducted a retrospective multi‐site analysis of pregnant and postpartum patients who underwent CVD risk assessment using a standardized tool between September 2020 and March 2024. Positive Predictive Value (PPV) was the primary performance metric. The positive predictive value of each element, domain, and physical exam findings was calculated. Model performance was assessed using multivariable logistic regression, Hosmer‐Lemeshow goodness‐of‐fit test, and concordance statistics (c‐statistics), with adjusted odds ratios and 95% confidence intervals. Results : Among 19,238 pregnant and postpartum patients, 2.3% of patients were later confirmed to have CVD. The original CVD risk assessment algorithm (Model O) comprised 18 variables and physical examination had a PPV of 15.6% [95% C.I. 0.1278–0.1887]. Physical examination findings were the most predictive elements of the CVD risk assessment, with heart murmur at 46.7% [0.3259–0.6130] and basilar crackles at 42.9% [0.1859–0.7111]. Model 1 (16 variables) and physical examination achieved a PPV of 19.5%. Model 2 (10 variables) yielded the highest PPV (24.8%) but identified fewer CVD cases, while Model 3 (8 variables) had a PPV of 17.7%. Model 1 had the highest discriminatory power, with a c‐statistic of 0.635. Conclusion : Model O demonstrates moderate predictive value and improves identification of undiagnosed CVD, with significant predictive enhancement utilizing physical exam findings. Although Model 2 achieved the highest PPV, its reduced case detection highlights the trade‐off between predictive precision and sensitivity. Model 1 provides optimal balance, improving PPV while maintaining broader case identification, and appears most practical for CVD risk assessment in pregnant and postpartum populations.

Michael Markus Robert Blank Medicover, MVZ‐Martinsried München, Germany Objective : To characterize endometrial microbiome patterns in fertility patients using large‐scale 16S rRNA NGS profiling and to explore whether these patterns may inform targeted therapeutic strategies. Study Design : We retrospectively analyzed ∼2,000 endocervical–endometrial samples collected between 2022 and early 2026 from fertility patients in Germany, Poland and Cyprus. Samples were processed using our EBIOM 16S rRNA NGS assay with automated bioinformatic classification into four predefined microbiome categories: Lactobacillus‐dominated (>80%), non‐Lactobacillus‐dominated with bacteria of unclear reproductive relevance, sterile, and non‐Lactobacillus‐dominated with bacteria previously associated with impaired reproductive outcomes. Targeted PCR for pathogens linked to chronic endometritis was performed on a subset. An exploratory case series of 13 patients was evaluated to document microbiome profiles, proposed interventions and early clinical observations. Results : Most samples were Lactobacillus‐dominated, but a substantial proportion showed non‐Lactobacillus‐dominated microbiota or bacteria previously associated with reduced IVF success. Sterile samples were also identified. These findings support four distinct microbiome categories with potential clinical implications. In the case series, six of 13 patients with suspicious microbiome findings received intrauterine antibiotic therapy, and probiotics were recommended to all. Microbiome results influenced clinical decision‐making, particularly regarding the consideration of targeted or conservative therapeutic approaches. Full statistical analysis and follow‐up are ongoing. Conclusion : Large‐scale microbiome profiling reveals heterogeneous and clinically relevant endometrial microbiome patterns in fertility patients. The proposed categorization may support more individualized and conservative therapeutic strategies. Ongoing follow‐up will clarify the potential impact of microbiome modulation on reproductive outcomes.

May Shabat 1 ; Michal Dishi 1 ; Liran Hiersch 1 ; Yariv Yogev 2 ; Danna englander 1 ; Uri Amikam 3 On behalf of Lis Maternity and Women's Hospital 1 Lis Maternity and Women's Hospital, Lis Maternity and Women's Hospital, Israel; 2 Lis Maternity & Women's Hospital, Tel‐Aviv Sourasky Medical Center, Tel‐Aviv, Israel, Tel AVIV, Israel; 3 Lis Maternity and Women's Hospital, Tel Aviv, Israel Objective : To evaluate different etiologies for intrauterine fetal demise (IUFD) according to different trimesters. Study Design : A single‐center retrospective cohort study including all IUFD cases as defined by ACOG (2015–2025). Terminations of pregnancy (TOP), cases with preterm prelabor rupture of membranes <23 weeks, and cases with unknown gestational age were excluded. The cohort was stratified into two groups according to gestational age at diagnosis of IUFD: 20 + 0 −27 + 6 weeks (2 nd trimester), and 28 + 0‐ 42 + 0 weeks (3 rd trimester). IUFD etiologies were categorized as follows: Placental – pathology findings including maternal vascular malperfusion, multiple placental infarcts, villitis of unknown origin, vasa previa, or chronic histiocytic intervillositis. Cord accident ‐ true knot or tight cord around the body and/or the fetal neck. nfectious – positive placental or fetal (oral or rectal) swabs, positive maternal cultures (Listeria Monocytogenes) or maternal positive serologies (IgM for Parvovirus/CMV/Toxoplasma, Syphyilis, and HIV). Feto‐maternal hemorrhage – positive Kleihauer‐Betke test or flow‐cytometry test. Lethal malformations or chromosomal abnormalities. Unknown etiology. Placental – pathology findings including maternal vascular malperfusion, multiple placental infarcts, villitis of unknown origin, vasa previa, or chronic histiocytic intervillositis. Cord accident ‐ true knot or tight cord around the body and/or the fetal neck. nfectious – positive placental or fetal (oral or rectal) swabs, positive maternal cultures (Listeria Monocytogenes) or maternal positive serologies (IgM for Parvovirus/CMV/Toxoplasma, Syphyilis, and HIV). Feto‐maternal hemorrhage – positive Kleihauer‐Betke test or flow‐cytometry test. Lethal malformations or chromosomal abnormalities. Unknown etiology. Results : Overall, 292 patients met inclusion criteria, of them, 102 (35.3%) cases in the 2 nd trimester, and 189 (64.8%) in the 3 rd trimester. Maternal and pregnancy characteristics were comparable between the two groups except for a higher rate of pregnancy achieved by assisted reproductive technology in the 2 nd trimester group (28.4% vs. 13.2%, p  < 0.01). Small‐for‐gestational‐age (birthweight <10th percentile by local charts), was significantly higher in the 2 nd trimester compared to the 3 rd trimester (50.9% vs. 14.8%, p  < 0.01, respectively). Cord accidents were significantly more frequent in the 3 rd trimester group (34.4% vs. 15.7%, p  < 0.01, respectively). Overall, 292 patients met inclusion criteria, of them, 102 (35.3%) cases in the 2 nd trimester, and 189 (64.8%) in the 3 rd trimester. Maternal and pregnancy characteristics were comparable between the two groups except for a higher rate of pregnancy achieved by assisted reproductive technology in the 2 nd trimester group (28.4% vs. 13.2%, p  < 0.01). Small‐for‐gestational‐age (birthweight <10th percentile by local charts), was significantly higher in the 2 nd trimester compared to the 3 rd trimester (50.9% vs. 14.8%, p  < 0.01, respectively). Cord accidents were significantly more frequent in the 3 rd trimester group (34.4% vs. 15.7%, p  < 0.01, respectively). Conclusion : An etiology for IUFD was identified in two‐thirds of cases, regardless of the trimester in which IUFD was identified. Cord accident was more prevalent in the 3 rd trimester, while SGA cases were more prevalent in the 2 nd trimester.

Temesgen Tantu Arusi; Yohanna aregawi Hailu On behalf of the Rwanda Society of Obstetrician and Gynecologists University of Rwanda, Kigali, Rwanda Objective : To assess the prevalence and associated factors with failed induction of labor at SPMMC, Addis Ababa, Ethiopia, over a two‐year period from January 01, 2021, to December 31, 2023. Study Design : An institution‐based retrospective cross‐sectional study was done. Results : The prevalence of failed induction of labor was found to be 15.5% (95% CI: 11.3–19.72). Multivariable logistic regression analysis showed that maternal age greater than 30 years (AOR = 2.7, 95% CI: 1.3–5.5), nulliparity (AOR = 2.4, 95% CI: 1.1–5.2), Bishop score less than 6 (AOR = 4.1, 95% CI: 1.9–8.6), premature rupture of membranes (AOR = 3.4, 95% CI: 1.3–8.6), and pregnancy‐induced hypertension (AOR = 3.2, 95% CI: 1.2–7.2) were significantly associated with failed induction of labor. Conclusion : Failed induction of labor was significantly associated with advanced maternal age, primiparity, unfavorable cervical status, premature rupture of membranes, and pregnancy‐induced hypertension. Careful consideration of pre‐induction conditions, particularly cervical readiness and the chosen method of induction, is essential to reduce failure rates and improve maternal and neonatal outcomes.

Sophie Tabouret 1 ; Aline Bakker‐de Groot 1 ; Julia Bakker 1 ; Anna Rietveld 1 ; Job van Exel 2 ; Christianne J. M. De Groot 3 1 Amsterdam UMC, Amsterdam, Netherlands; 2 Erasmus, Rotterdam, Netherlands; 3 Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, Netherlands Objective : The Dutch maternity care system is internationally recognized for its midwife‐led, community‐based model. However, persistent shortages of obstetric nurses and hospital‐based midwives increasingly strain the system. Integrating nursing and midwifery roles into a unified nurse–midwife model has been proposed as a workforce strategy. This study systematically explores stakeholder perspectives on implementing such a role and identifies perceived facilitators and barriers. Study Design : A Q methodology study was conducted to identify stakeholder viewpoints. Participants ranked 31 statements on professional, organizational, and client‐related implications and discussed these in follow‐up interviews. Statements were developed in consultation with midwives, obstetric nurses, obstetricians, educational institutions, professional organizations, municipalities, patient representatives, insurers, and maternity care networks. By‐person factor analysis identified distinct viewpoints, supported by qualitative data. Results : Four viewpoints emerged. One emphasized professional development, job satisfaction, and improved patient experience without expecting workload reduction. Another highlighted improved continuity within care teams and potential to address workforce shortages, particularly for nurses transitioning into midwifery. A third raised concerns about midwifery autonomy and questioned improvements in care quality, while acknowledging increased educational accessibility. The fourth framed the role as an innovative response to workforce pressures, expecting improved continuity and reduced interventions. Across viewpoints, workforce sustainability and continuity were central, while tensions concerned autonomy, role boundaries, and system integration. Conclusion : Stakeholder perspectives reveal both support and professional tensions. While the role is seen as promising for workforce sustainability and continuity of care, concerns about autonomy and role boundaries persist. Successful implementation requires alignment with professional identities, organizational structures, and education.

Jillian W. Jetmore 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 compare maternal and neonatal outcomes in patients with Type 1 diabetes (T1D) using insulin pump versus multiple daily injections (MDI). Study Design : This was a retrospective study of patients with T1D wearing a continuous glucose monitor who were receiving insulin therapy with either a pump or MDI. The primary outcomes were composites of adverse maternal outcomes (postpartum hemorrhage, thromboembolism, acute kidney injury, intensive care admission, and maternal death) and adverse neonatal outcomes (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, seizures, shoulder dystocia, confirmed sepsis or infection, hypotension requiring vasopressors, hyperbilirubinemia requiring phototherapy, bronchopulmonary dysplasia, hypoglycemia requiring IV glucose, retinopathy of prematurity, periventricular leukomalacia, stillbirth, and neonatal death.). Secondary outcomes included preterm birth <37 weeks. Univariable and multivariable logistic regression analyses were performed. Results : The study included 179 pregnancies in 169 individuals with T1D. Patients were managed with either insulin pump therapy ( n  = 158) or MDI ( n  = 21). There were no differences in glycemic control, nor adverse maternal outcomes, neonatal outcomes, or preterm birth between the study groups (Tables 1–2). Conclusion : We did not find differences in glycemic control or adverse maternal or neonatal outcome in pregnancy complicated by T1D using insulin pump versus MDI. However, the study is limited by its small sample size, and had 60% power to detect a 50% reduction in the primary outcome. Larger studies are needed to verify these findings.

Erin Fey St. Louis University/SSM Health, St. Louis, MO Objective : Non‐invasive prenatal testing (NIPT) typically results in low‐ or high‐risk results. When results are atypical, further testing may be indicated. This study highlights what genetic testing is appropriate following an atypical NIPT result and when expected inheritance may lead to an unexpected outcome. Study Design : With NIPT results we hypothesized that there could be a maternal or fetal sex chromosome difference. After discovering a maternal recombinant X chromosome, we hypothesized autosomal dominant inheritance to pass on the recombinant X. Results : A G4P0030 female had NIPT which was low risk for trisomies but was noted to have a “disproportionate representation of X chromosome” using a counting‐based NIPT. SNP‐based NIPT was drawn. Results were low risk for trisomies but atypical finding on sex chromosomes which was suspected to be maternal in origin. Possible reasons for this result include normal variation, maternal mosaicism, or maternal X chromosome abnormality. Maternal chromosomal microarray (CMA) was performed which was abnormal for a pathogenic likely recombinant X chromosome, specifically an Xp22.33p21.1 deletion and Xq24q28 duplication. Following autosomal dominant inheritance, this pregnancy there is a 50% chance the patient will pass on the recombinant X. After delivery CMA was performed which revealed 47, XX, +rec(X)(qter‐ >q24::p21.1‐ >qter) which results in Xp21.1q24 duplication & Xq24q28 triplication : two typical X chromosomes, and the maternal recombinant X chromosome. Conclusion : NIPT results be high risk for aneuploidies but can be atypical for other differences within chromosomes. Clinicians should be familiar with the nuances of NIPT testing platforms as well as follow up testing. The counting‐based method cannot distinguish between fetal and maternal DNA whereas the SNP‐cased method may guide further testing strategies. This case report highlights the unique nature of genetics. Autosomal dominant inheritance of the maternal recombinant X chromosome is expected. However, the patient's child inherited two typical X chromosomes and the maternal recombinant X chromosome.

Thea Lorraine R. Tugon; Joanna Pauline Chua‐Ursua East Avenue Medical Center, Quezon City, Philippines Objective : To outline the features of complete diprosopus using prenatal ultrasound and fetal neurosonography. To identify the roles and the diagnostic and prognostic challenges in the assessment of rare congenital anomalies in low resource setting. To accentuate the importance of multidisciplinary, compassionate, culturally sensitive and empathetic counseling in parental decision making. To outline the features of complete diprosopus using prenatal ultrasound and fetal neurosonography. To identify the roles and the diagnostic and prognostic challenges in the assessment of rare congenital anomalies in low resource setting. To accentuate the importance of multidisciplinary, compassionate, culturally sensitive and empathetic counseling in parental decision making. Study Design : Case Report. Results : Case Summary : We present a prenatally diagnosed case of complete diprosopus at 31 weeks gestation. Targeted ultrasonography identified duplicated midline facial structures and severe intracranial abnormalities. While fetal MRI could have provided additional anatomical detail, serial targeted prenatal ultrasounds were sufficient to establish the diagnosis. Given the uniformly lethal prognosis and absence of viable postnatal interventions, detailed and empathetic multidisciplinary counseling was provided. Ethical considerations—including communication of prognosis, emotional burden, and the limits of medical intervention—were central to shared decision‐making. Perinatal palliative care was planned, and expectant management was pursued. The neonate was delivered via classical cesarean section and expired shortly after birth. Postmortem MRI confirmed the extent of anomalies. This case highlights the diagnostic and prognostic challenges of diprosopus, especially in resource‐limited settings. Fetal neurosonography enhances diagnostic confidence by delineating duplicated cranial structures. Counseling must be evidence‐based, empathetic, and culturally sensitive. A multidisciplinary team—including maternal‐fetal medicine specialists, neonatologists, and psychosocial support—is essential for providing comprehensive, family‐centered care. Conclusion : Complete diprosopus exemplifies the diagnostic and ethical complexities encountered in maternal‐fetal medicine. Early detection, detailed imaging, and multidisciplinary collaboration are critical in guiding management and supporting affected families.

Chen Berkovitz Edelshtein 1 ; Katia Orvin 2 ; Eran Hadar 3 ; Shira Hazon 4 ; Michal Yackobovtich Gavan 5 ; Keren Tzadikevitch Geffen 6 On behalf of Tel Aviv University, Tel Aviv, Israel 1 Sheba Medical Center, Ramat Gan, Israel; 2 Rabin Medical Center, Petah Tikva, Israel; 3 Maternal‐Fetal Medicine Unit, Rabin Medical Center, Petach Tikva, Israel; 4 Rabin Medical Center, Petach Tikva, Israel; 5 Schneider Children's Medical Center, Petach Tikva, Israel; 6 Maternal‐Fetal Medicine Unit, Rabin Medical Center, Petah Tikva, Israel Objective : Pregnancy induces transient metabolic changes. Frequent pregnancies with short recovery intervals may exacerbate these effects, potentially influencing long‐term maternal cardiovascular health. This study examined the association between the number of short interbirth intervals (IBI), defined as <15 or 35 years at data retrieval (January 2025) with ≥2 deliveries, using the electronic database of Clalit Health Services in Israel. Each case (IHD) was randomly matched to one control (No IHD) by year of birth and parity. The final cohort included 193,560 women (96,780 in each group). Univariate comparisons were performed between cases and controls. Conditional logistic regression models evaluated the association between the number of short IBIs and the odds of IHD, adjusting for sociodemographic and cardiovascular confounders. Results : Women with IHD had a higher prevalence of short IBIs; for IBI < 15 months, they were more likely to have one short IBI (13.6% vs. 13.0%), two short IBIs (2.9% vs. 2.6%), and ≥3 short IBIs (1.2% vs. 1.1%, p  < 0.001). For IBI < 33 months, the difference was most evident in the category of two short IBIs (12.8% vs. 12.3%, p  = 0.008) (Table 1). Adjusted conditional logistic regression models demonstrated that a higher number of short IBIs was associated with increased odds of IHD. Each additional short IBI < 15 months increased the odds of IHD by 6.3% (aOR = 1.063, 95% CI 1.037–1.090, p  < 0.001), and each additional short IBI < 33 months by 5.9% (aOR = 1.059, 95% CI 1.041–1.078, p  < 0.001) (Table 2). Conclusion : Multiple short IBIs are associated with higher long‐term odds of maternal IHD. Reproductive history may be considered for cardiovascular risk assessment. Encouraging adequate birth spacing for women of reproductive age may serve as a public health measure to reduce future cardiovascular morbidity.

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