Labor characteristics and Perinatal Outcomes Associated with Low Molecular Weight Heparin Therapy: Differential Effects in Induced versus Spontaneous Labor

Labor characteristics and Perinatal Outcomes Associated with Low Molecular Weight Heparin Therapy: Differential Effects in Induced versus Spontaneous Labor | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Labor characteristics and Perinatal Outcomes Associated with Low Molecular Weight Heparin Therapy: Differential Effects in Induced versus Spontaneous Labor Kechen Li, Li Zhou, Jieni Zou, Zhaoxia Huang, Ke Dong, Yujia Zhou, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8700142/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 20 You are reading this latest preprint version Abstract Objective: To evaluate the effects of long-term low molecular weight heparin (LMWH) use during pregnancy on labor process and pregnancy outcomes under different labor onset methods, aiming to inform clinical application strategies. Methods: This retrospective cohort study included parturients from November 2020 to November 2024. Subjects were grouped based on LMWH exposure and matched using propensity score matching (PSM, 1:2 ratio) for six baseline variables. Subgroup analyses were conducted by labor onset mode (induced vs. spontaneous). Clinical data, pregnancy complications, medications, delivery interventions, and pregnancy outcomes were compared. Multivariate regression analyses were used to assess LMWH’s effects. Results: LMWH use was associated with increased postpartum hemorrhage (PPH) risk (aOR = 2.497, P = 0.032) but reduced CS rates (aOR = 0.617, P = 0.027). In vaginal deliveries, LMWH users showed higher risks of forceps-assisted delivery (aOR = 3.512, P = 0.022) and episiotomy (aOR = 3.059, P = 0.007). In spontaneous labor, LMWH was linked to greater intrapartum blood loss and PPH risk. No significant impact was found on labor duration or neonatal outcomes. Conclusions: Long-term antenatal LMWH use increases PPH and operative vaginal delivery risk, particularly under spontaneous labor. Findings support individualized labor management in LMWH-treated pregnancies. molecular-weight heparin labor induced pregnancy outcome postpartum hemorrhage anticoagulants cesarean section Figures Figure 1 INTRODUCTION Low molecular weight heparin (LMWH) is a well-established anticoagulant for venous thromboembolism (VTE) prophylaxis and treatment during pregnancy[ 1 ]. Beyond its fundamental anticoagulant activity, LMWH possesses unique biological properties including immunomodulatory effects (through complement inhibition and cytokine regulation), the ability to enhance trophoblast invasion, and improvement of uteroplacental circulation[ 2 , 3 ]. These mechanisms have contributed to its increasing use in selected high-risk pregnancies, such as those with antiphospholipid syndrome (APS), recurrent spontaneous abortion (RSA), or assisted reproductive technology (ART) [ 2 ]. Its favorable safety profile, characterized by minimal placental transfer and negligible excretion into breast milk, further supports its use during pregnancy and lactation[ 4 ]. Despite limited evidence supporting its efficacy for placenta-mediated complications such as preeclampsia and fetal growth restriction, LMWH is frequently employed in clinical practice, often based on physician preference. Furthermore, it is well-known that quite many infertility clinics disregards the official recommendations from official societies and still use a lot of LMWH despite the lack of evidence of its effects. Given its widespread clinical application, this study was conducted to evaluate the effects of LMWH on labor progression and delivery outcomes. In vitro studies suggest that LMWH may augment labor progression through dual pathways: potentiating uterine smooth muscle contractility via specific signaling cascades and accelerating cervical maturation by stimulating interleukin-8 (IL-8) secretion from cervical fibroblasts[ 5 ]. Although some clinical reports associate LMWH with shortened first-stage labor[ 6 ], others found no significant association after adjusting for confounders[ 7 ]. Similarly, concerns regarding the risk of PPH persist, as the available evidence on the relationship between LMWH and PPH remains controversial[ 8 , 9 ]. Furthermore, LMWH’s modulation of trophoblast biology raises unanswered questions about its influence on placental separation disorders (e.g., adhesion/accreta), warranting further investigation. Induction of labor (IOL) is more commonly carried out in pregnancies that necessitate LMWH therapy [ 10 ]. This is mainly because there is a dual requirement to manage the underlying high - risk conditions and to optimize anticoagulation control. According to guideline recommendations, LMWH should be discontinued 24 hours before delivery to minimize bleeding risks[ 11 ]. Planned induction enables precise coordination between the timing of the last anticoagulant dose and the delivery, thus maintaining effective thromboprophylaxis while reducing the risk of hemorrhage. Women were instructed to withhold further self-administered LMWH once labor commenced and were reassessed upon admission. Importantly, no evidence indicates that IOL is superior or safer than spontaneous labor specifically in LMWH-treated women, and both approaches are considered acceptable in current clinical practice. It is crucial to note that IOL itself can have a significant impact on labor outcomes, potentially increasing the rates of cesarean delivery and postpartum hemorrhage (PPH). However, in LMWH-treated pregnancies, the specific effects of induction on labor characteristics, intrapartum interventions, and delivery outcomes remain poorly understood. Therefore, we conducted a retrospective cohort study to evaluate the clinical characteristics and pregnancy outcomes in LMWH-treated pregnancies. Through stratified analysis by onset of labor (spontaneous versus induced), we specifically examined how labor induction influences labor progression, intrapartum interventions, and delivery outcomes in this population. Our findings provide critical evidence to optimize anticoagulation management and delivery planning in pregnancies requiring LMWH therapy. METHODS Study design and subjects This retrospective cohort study included women who delivered at our hospital between November 2020 and November 2024. Our centre is a tertiary care referral centre with over 10000 deliveries per year. Eligible participants were those with singleton live births at ≥ 28 weeks' gestation. Exclusion criteria consisted of: (1) incomplete clinical data; (2) pre-pregnancy BMI < 18 kg/m²; (3) intermittent LMWH use (cumulative duration < 20 weeks); (4) cervical insufficiency or genital tract malformations; (5) stillbirth or fetal demise; (6) severe comorbidities (including cardiac disease, thrombocytopenia, hemophilia, liver disease, or kidney disease). The study was approved by the Institutional Review Board (Ethics Approval No.: 2024-K-111-01). Long-term LMWH users were defined as women receiving LMWH for ≥ 20 gestational weeks, verified through prescription records and medication administration logs. Women with < 20 cumulative weeks of LMWH exposure were excluded from both groups, as this population was highly heterogeneous, including those receiving short-term LMWH during the first trimester for assisted reproduction, late-pregnancy treatment initiated for elevated D-dimer levels or newly diagnosed fetal growth restriction, or treatment commenced after a late venous thromboembolic event. Excluding these cases allowed us to maintain a homogeneous exposure definition and focus on the effects of long-term, continuous antenatal LMWH use. Participants were categorized into LMWH and non-LMWH (control) groups. All women in the LMWH group received continuous antenatal LMWH therapy rathe r than intermittent or symptom-triggered dosing. In our institution, LMWH is administered using standard pre-filled syringes (4000–5000 IU per dose), given once or twice daily (qd or bid) according to maternal weight and thrombotic risk. Because dose regimens varied across gestation and could not be reliably categorized into fixed prophylactic or therapeutic groups, LMWH exposure was analyzed as a binary variable (use vs. no use). To control for potential confounders, PSM was performed in a 1:2 ratio using a caliper value of 0.05, matching for maternal age, pre-pregnancy BMI, gravidity, parity, ART use, and gestational age at delivery. Subgroup analyses were subsequently conducted based on labor onset type (induced vs. spontaneous) and delivery mode (vaginal vs. cesarean section (CS)). Data collection We systematically collected maternal and neonatal clinical data from electronic medical records, including three key domains: (1) Maternal characteristics-comprising demographic factors (age, gravidity, parity, BMI at delivery, ART use), pre-existing medical conditions (hypothyroidism, pregestational diabetes, chronic hypertension), and pregnancy complications (HDP, hyperglycemia in pregnancy, ICP), and medication exposure (P4, Long-term low-dose aspirin (ASA), Immunosuppressants (e.g., cyclosporine, prednisone)); (2) Labor management details-documenting labor onset type (induced with Bishop score-based methods or spontaneous), delivery mode (vaginal or cesarean), labor durations, and intrapartum interventions (artificial rupture of membranes (AROM), phloroglucinol or oxytocin use, forceps delivery, episiotomy, epidural analgesia, mediolateral episiotomy and manual placental removal) performed according to ACOG guidelines (Vacuum extraction is not routinely practiced at our center and thus was not included as an outcome measure)[ 12 ]; and (3) Outcome measures-evaluating both maternal (PPH, premature rupture of membranes (PROM), placental adhesion, placental abruption, placenta accreta and oligohydramnios) and neonatal outcomes (birth weight, Apgar scores, neonatal asphyxia, macrosomia, and SGA infants). Additionally, we collected data on indications for LMWH use, which included: APS, thrombophilia (both inherited and acquired), in vitro fertilization (IVF) cycles, RSA, prior thrombosis history, and other combined or unclassified indications ('other combined indications' referred to cases not meeting the above specific categories). All LMWH-treated patients initiated prophylactic or therapeutic regimens in early pregnancy (≤ 12 gestational weeks), maintaining treatment until late pregnancy (minimum duration ≥ 20 weeks). Per current guidelines[ 13 ], standardized peripartum management ensured LMWH discontinuation ≥ 24 hours before delivery. For patients without spontaneous labor onset, delivery was scheduled (either induction or CS) based on obstetric indications or maternal preference to optimize pregnancy outcomes. Relative definitions In this study, cesarean sections were categorized as elective or intrapartum. Elective CS refers to pre-planned surgery based on medical indications (e.g., malpresentation, placenta previa, multiple gestation) or maternal request before the onset of labor. Intrapartum CS refers to emergency conversion to cesarean delivery during a trial of labor due to maternal or fetal complications (e.g., labor arrest, fetal distress, umbilical cord prolapse. PPH was defined using calibrated collection devices and quantitative weighing (weighing of pads and drapes). Definitions followed the ISTH criteria and major obstetric society guidelines: ≥500 mL for vaginal delivery or ≥ 1000 mL for cesarean delivery within 24 hours[ 14 ]. Placental adhesion[ 15 ] required surgical confirmation of failed separation, while placenta accreta[ 16 ] demanded histopathological evidence of villous myometrial invasion. Quantitative thresholds defined oligohydramnios (amniotic fluid volume ≤ 300mL)[ 17 ]. PROM was defined as the spontaneous rupture of fetal membranes before the onset of labor[ 18 ]. Labor induction protocols were Bishop score-dependent: cervical balloon ripening for scores < 6 versus oxytocin/artificial rupture of membranes for scores ≥ 6. Uterine inertia management included oxytocin augmentation (starting at 2 mU/min, increased by 2 mU/min every 15–30 minutes until adequate contractions) and amniotomy. Phloroglucinol is thought to facilitate labour by reducing spasms and oedema of the cervix, harmonize shrinkage of the uterus[ 19 ]. Operative vaginal births adhered to FIGO guidelines: forceps application at station ≥ + 2 due to fetal compromise or arrest. Episiotomies were selectively performed by senior obstetricians (≥ 10 years’ experience)[ 20 ]. Epidural analgesia utilized 0.1% ropivacaine with 0.33µg/mL sufentanil, initiated after a negative test dose (1% lidocaine). Oxytocin injection via the umbilical vein or manual placental removal was employed in cases of difficult placental delivery to shorten the third stage of labor. Active labour was defined according to contemporary obstetric guidance as cervical dilation ≥ 6 cm, and labor stages were timed per FIGO guidelines: first stage (onset to full dilation), second (dilation to delivery), and third (delivery to placental expulsion)[ 20 ]. All timings (labor stages, LMWH discontinuation) followed synchronized electronic clock documentation. Statistical Analysis All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables with normal distribution were expressed as mean ± standard deviation (Mean ± SD), and comparisons between groups were performed using the independent-samples t test. For non-normally distributed continuous variables, data were presented as median and interquartile range (Median [P25, P75]), and the Mann–Whitney U test (non-parametric test) was used for group comparisons. Categorical variables were expressed as frequencies and percentages (n [%]), and comparisons between groups were conducted using the Pearson chi-square test or Fisher’s exact test, as appropriate. All statistical tests were two-tailed, and a P -value < 0.05 was considered statistically significant. To further investigate the associations between LMWH use during pregnancy and delivery process as well as pregnancy outcomes, logistic regression and linear regression analyses were performed. Both crude and adjusted odds ratios (ORs) or regression coefficients (Beta, B) with their corresponding 95% confidence intervals (95% CIs) were calculated to ensure the robustness of the results. RESULTS As shown in Fig. 1 , a total of 34,662 parturients delivered at our hospital during the study period, among whom 4,606 women were excluded due to the following reasons: (1) twin or multiple pregnancies (n = 1,137); (2) gestational age < 28 weeks (n = 130); (3) incomplete medical records (n = 312); (4) intermittent use of LMWH with a treatment duration of less than 20 weeks (n = 1,675); (5) BMI < 18 kg/m² (n = 135); (6) reproductive tract malformations (n = 393); (7) stillbirth or fetal death (n = 6); and (8) severe medical or surgical comorbidities (n = 818). The remaining 30,056 eligible parturients were divided into two groups: long-term LMWH users (≥ 20 weeks, n = 348) and non-LMWH users (n = 29,708). Using PSM at a 1:2 ratio, adjusted for maternal age, BMI at the time of delivery, gravidity, parity, ART, and gestational age at delivery, we established matched cohorts of 348 LMWH users and 696 non-users. After excluding cases involving elective cesarean deliveries (167 in the LMWH group and 322 in the control group), the remaining participants were stratified according to the mode of labor onset. In the LMWH group (n = 181), there were 92 induced labors and 89 spontaneous labors, whereas the control group (n = 374) included 133 induced labors and 241 spontaneous labors. For each subgroup, we report the numbers of vaginal deliveries and intrapartum cesarean conversions. Maternal and neonatal outcomes in LMWH group and control group As shown in Table 1 , there were no significant differences in demographic characteristics or maternal complications—including gestational hyperglycemia, HDP, and ICP—or neonatal birth weight between the LMWH group and the control group ( P > 0.05). However, the incidence of gestational hypothyroidism was significantly higher in the LMWH group compared to the control group ( P < 0.05). Additionally, the proportions of concomitant use of P4, ASA, and immunosuppressants were all significantly greater in the LMWH group ( P < 0.05). The primary indications for LMWH administration during pregnancy were prethrombotic state (50.5%), followed by APS (29.0%) and a history of RSA (4.3%) (Table 1 ). Table 1 Baseline characteristics of the study population (singleton live births ≥ 28 weeks, including elective cesarean section) LMWH Group (n = 348) Non-LMWH Group (n = 696) P Age (years) 31.48 ± 4.12 31.86 ± 4.73 0.185 BMI (kg/m 2 ) 26.48 ± 3.47 26.51 ± 3.48 0.878 Gravidity 2 (1, 4) 2 (2, 4) 0.276 Parity 0 (0, 1) 0 (0, 1) 0.244 ART (%) 79 (22.7) 148 (21.3) 0.596 Gestational age (week) 38.10 ± 1.47 38.04 ± 2.10 0.565 Gestational hyperglycemia (%) 85 (24.4) 139 (20.0) 0.098 HDP (%) 36 (10.3) 70 (10.1) 0.885 ICP (%) 7 (2.0) 6 (0.9) 0.200 Gestational hypothyroidism (%) 53 (15.2) 57 (8.2) <0.001 P4 (%) 99 (28.4) 42 (6.0) < 0.001 ASA (%) 245 (70.4) 20 (2.9) <0.001 Immunosuppressant (%) 220 (63.2) 15 (2.2) < 0.001 APS 101 (29.0) Prethrombotic state 176 (50.5) IVF 16 (4.5) RSA 15 (4.3) History of thrombosis 1 (0.2) Other causes 39 (11.2) Abbreviations: BMI, body mass index; ART, assisted reproductive technology; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis of pregnancy; P4, progesterone; ASA, acetylsalicylic acid; APS, antiphospholipid syndrome; IVF, in vitro fertilization; RSA, recurrent spontaneous abortion. There were no significant differences in major pregnancy outcomes between the LMWH and control groups, including rates of PROM, PPH, placental adhesion, placenta accreta, placental abruption, oligohydramnios, neonatal asphyxia, macrosomia, SGA, and Apgar scores at 1 and 5 minutes ( P > 0.05). While initial CS rates appeared comparable between groups ( P > 0.05), multivariate analysis adjusting for hypothyroidism, ASA use, immunosuppressant therapy, and P4 administration revealed the LMWH group had significantly lower odds of total cesarean delivery (aOR = 0.617, 95% CI: 0.402–0.945, P = 0.027) but significantly higher odds of PPH (aOR = 2.497, 95% CI: 1.084–5.571, P = 0.032). No other statistically significant differences in pregnancy outcomes were observed between groups ( P > 0.05)(Table 2 ). Table 2 Maternal and Neonatal Outcomes in LMWH and Reference Groups LMWH Group (n = 348) Non-LMWH Group (n = 696) OR/B (95% CI) P aOR/aB (95% CI) Adjusted P Maternal Outcomes Total cesarean section (%) 182 (52.3) 369 (53.0) 0.972 (0.751, 1.257) 0.827 0.617 (0.402, 0.945) 0.027 Elective cesarean section (%) 167 (48.0) 322 (46.3) 1.072 (0.828, 1.387) 0.599 0.723 (0.472, 1.108) 0.137 PROM (%) 60 (17.2) 135 (19.4) 0.866 (0.619, 1.211) 0.400 1.179 (0.689, 2.016) 0.548 PPH (%) 18 (5.2) 33 (4.7) 1.096 (0.608, 1.976) 0.761 2.497 (1.084, 5.571) 0.032 Placental adhesion (%) 18 (5.2) 41 (5.9) 0.871 (0.493, 1.540) 0.636 0.450 (0.168, 1.204) 0.112 Placenta accreta (%) 5 (1.4) 7 (1.0) 1.435 (0.452, 4.554) 0.538 0.901 (0.120, 6.767) 0.919 Placental abruption (%) 3 (0.9) 5 (0.7) 1.202 (0.286, 5.058) 0.802 2.800 (0.370, 21.163) 0.318 Oligohydramnios (%) 25 (7.2) 50 (7.2) 1.000 (0.608, 1.646) 1.000 0.666 (0.280, 1.581) 0.357 Neonatal Outcomes Neonatal birth weight (g) 3142.07 ± 425.45 3158.58 ± 554.23 −16.5 0.594 1-min Apgar score 10 (10, 10) 10 (10, 10) 9.839 (9.805, 9.874) 0.157 0.037 (-0.061, 0.134) 0.458 5-min Apgar score 10 (10, 10) 10 (10, 10) 9.984 (9.946, 10.023) 0.966 0.005 (-0.104, 0.114) 0.924 Neonatal asphyxia (%) 1 (0.3) 4 (0.6) 0.499 (0.056, 4.477) 0.534 0.205 (0.003, 15.999) 0.476 Macrosomia (%) 22 (3.2) 9 (2.6) 0.813 (0.370, 1.786) 0.607 0.949 (0.284, 3.176) 0.933 SGA (%) 10 (2.9) 22 (3.2) 0.906 (0.424, 1.936) 0.800 0.428 (0.118, 1.552) 0.197 Abbreviations: OR, Odds Ratio; aOR, Adjusted Odds Ratio; B, Coefficient B; aB, Adjusted Coefficient B; PROM, premature rupture of membrane; PPH, postpartum hemorrhage; SGA, small for gestational age. Confounding factors adjusted for: gestational hypothyroidism, use of aspirin (ASA), immunosuppressants, and progesterone (P4). Maternal and neonatal outcomes in LMWH and control groups undergoing trial of vaginal delivery A subgroup analysis was performed among parturients who underwent a trial of vaginal delivery. Compared with the control subgroup, the LMWH subgroup exhibited significantly higher rates of gestational hyperglycemia, labor induction, and concomitant use of medications, including P4, ASA and immunosuppressants ( P < 0.05). In contrast, no statistically significant differences were observed between the two subgroups in terms of maternal age, gravidity, parity, BMI, gestational age at delivery, use of ART, or the incidence of HDP, gestational hypothyroidism, ICP, or neonatal birth weight ( P > 0.05) (Table 3 ). Table 3 Baseline Characteristics of Parturients Undergoing Trial of Vaginal Delivery in LMWH and Reference Groups LMWH Subgroup (n = 181) Non-LMWH Subgroup (n = 374) P Maternal age (years) 30.62 ± 4.14 30.64 ± 4.22 0.958 BMI (kg/m^2) 26.28 ± 3.22 26.06 ± 3.39 0.467 Gravidity 2 (2, 3) 2 (1, 3) 0.067 Parity 0 (0, 0) 0 (0, 1) 0.187 ART (%) 23 (12.7) 54 (14.1) 0.580 Gestational age (weeks) 38.49 ± 1.37 38.55 ± 1.89 0.633 Gestational hyperglycemia (%) 40 (22.1) 57 (15.2) 0.046 HDP (%) 16 (8.8) 27 (7.2) 0.503 Gestational hypothyroidism (%) 24 (13.3) 34 (9.1) 0.132 ICP (%) 2 (1.1) 3 (0.8) 1.000 Combined medication (%) P4 50 (27.6) 17 (4.5) <0.001 ASA 126 (69.6) 4 (1.1) <0.001 Immunosuppressants 111 (61.3) 3 (0.8) <0.001 Induction of labor (%) 92 (50.8) 133 (35.6) 0.001 Abbreviations: BMI, body mass index; ART, assisted reproductive technology; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis of pregnancy; P4, progesterone; ASA, acetylsalicylic acid. No statistically significant differences were observed between the LMWH and control subgroups in major pregnancy outcomes, including intrapartum CS, elective CS, PROM, PPH, placental adhesion, placenta accreta, placental abruption, oligohydramnios, neonatal asphyxia, macrosomia, SGA, or Apgar scores at 1 and 5 minutes ( P > 0.05). After adjusting for gestational hyperglycemia, induction of labor, and concomitant use of ASA, immunosuppressants, and P4, multivariate regression analysis demonstrated that the LMWH subgroup had a significantly lower risk of intrapartum cesarean delivery compared with the control subgroup (adjusted odds ratio [aOR] = 0.264; 95% confidence interval [CI]: 0.074–0.957; P = 0.043). Although the incidence of PPH did not differ significantly between groups, the LMWH subgroup experienced significantly greater intrapartum blood loss during vaginal delivery (adjusted β = 40.829; 95% CI: 6.135–75.523; P = 0.021). No other significant differences in maternal or neonatal outcomes were detected between the subgroups ( P > 0.05) (Table 4 ). Table 4 Maternal and Neonatal Outcomes in LMWH and Reference Groups Undergoing Trial of Vaginal Delivery LMWH Subgroup (n = 181) Non-LMWH Subgroup (n = 374) OR/B (95% CI) P aOR/aB (95% CI) Adjusted P Maternal PROM (%) 40 (22.1) 91 (24.3) 0.882 (0.578, 1.347) 0.562 1.222 (0.595, 2.508) 0.585 PPH (%) 15 (8.3) 28 (7.5) 1.117 (0.581, 2.147) 0.741 2.206 (0.844, 5.768) 0.107 Intrapartum cesarean section (%) 15 (8.3) 47 (12.7) 0.629 (0.341, 1.158) 0.136 0.264 (0.074, 0.957) 0.043 Intrapartum blood loss (ml) 300 (300, 300) 300 (300, 400) -29.220 (-67.680, 9.241) 0.134 -38.479 (-167.391, 90.434) 0.552 Vaginal Delivery Intrapartum blood loss (ml) 100 (100, 200) 100 (100, 200) -6.471 (-27.204, 14.261) 0.540 40.829 (6.135, 75.523) 0.021 2-hour postpartum blood loss (ml) 70 (50, 90) 70 (50, 100) 13.254 (-18.951, 45.458) 0.419 9.488 (-44.753, 63.728) 0.731 Placental adhesion (%) 4 (2.4) 11 (3.4) 0.747 (0.295, 1.995) 0.587 1.036 (0.226, 4.741) 0.964 Placenta accreta (%) 1 (0.6) 0 (0.0) - 0.994 - 0.993 Placental abruption (%) 3 (1.7) 0 (0.0) - 0.993 - 0.993 Oligohydramnios (%) 7 (3.9) 20 (5.3) 0.712 (0.295, 1.716) 0.449 0.739 (0.177, 3.090) 0.679 Neonatal Neonatal birth weight (g) 3174.70 ± 366.39 3184.61 ± 472.58 -0.248 0.804 1-min Apgar score 10 (10, 10) 10 (10, 10) -0.001 (-0.068, 0.066) 0.976 0.034 (-0.082, 0.150) 0.564 5-min Apgar score 10 (10, 10) 10 (10, 10) 0.021 (-0.049, 0.091) 0.555 -0.008 (-0.113, 0.130) 0.892 Neonatal asphyxia (%) 0 (0.0) 1 (0.3) - 0.966 - 0.997 Macrosomia (%) 3 (1.7) 6 (1.6) 1.034 (0.256, 4.181) 0.963 0.956 (0.098, 9.331) 0.969 SGA (%) 4 (2.2) 5 (1.3) 1.668 (0.422, 6.287) 0.450 0.455 (0.034, 6.021) 0.550 Abbreviations: OR, Odds ratio; aOR, Adjusted odds ratio; B, Regression coefficient; aB, Adjusted regression coefficient; PROM, premature rupture of membrane; PPH, postpartum hemorrhage; SGA, small for gestational age. Confounders adjusted for: gestational hyperglycemia, induction of labor, and use of ASA, immunosuppressants, and P4. Intrapartum interventions and labor duration in LMWH and control groups undergoing vaginal delivery A subgroup analysis was conducted among parturients who underwent vaginal delivery. Compared with the control subgroup, the LMWH subgroup demonstrated significantly higher rates of episiotomy and intrapartum oxytocin infusion ( P < 0.05). However, no significant differences were observed between groups in the use of artificial rupture of membranes, phloroglucinol administration, epidural analgesia, forceps-assisted delivery, umbilical vein oxytocin injection, manual removal of the placenta, or the duration of labor stages ( P > 0.05). After adjusting for gestational hyperglycemia, labor induction, and the use of ASA, immunosuppressants, and P4, multivariate regression analysis revealed that the LMWH subgroup had significantly increased odds of both forceps-assisted delivery (adjusted odds ratio [aOR] = 3.512; 95% confidence interval [CI]: 1.195–10.325; P = 0.022) and episiotomy (aOR = 3.059; 95% CI: 1.353–6.914; P = 0.007). No other significant differences were found in intrapartum interventions or labor durations after adjustment ( P > 0.05) (Table 5 ). Table 5 Intrapartum Interventions and Labor Duration in LMWH and Reference Groups Undergoing Vaginal Delivery LMWH subgroup (n = 166) Non-LMWH Subgroup (n = 327) OR/ B (95% CI) P aOR/ aB (95% CI) Adjusted P Forceps-assisted delivery (%) 12 (7.2) 15 (4.6) 1.616 (0.738, 3.536) 0.230 3.512 (1.195, 10.325) 0.022 Episiotomy (%) 28 (16.9) 34 (10.4) 1.749 (1.019, 2.999) 0.042 3.059 (1.353, 6.914) 0.007 Phloroglucinol IV push (%) 19 (11.4) 49 (15.0) 0.733 (0.416, 1.292) 0.283 0.753 (0.294, 1.926) 0.553 Epidural analgesia (%) 142 (85.5) 284 (86.9) 0.896 (0.523, 1.535) 0.689 0.850 (0.341, 2.118) 0.728 Oxytocin infusion (%) 115 (69.3) 159 (48.6) 2.383 (1.606, 3.535) <0.001 2.015 (0.987, 4.114) 0.055 Artificial rupture of membranes (%) 17 (10.2) 40 (12.2) 0.819 (0.449, 1.493) 0.514 1.276 (0.467, 3.487) 0.635 First stage (h) 7.59 (5.31, 10.87) 8.67 (5.00, 12.50) -0.806 (-1.668, 0.057) 0.067 -0.320 (-1.773, 1.134) 0.666 Second stage (h) 0.95 (0.52, 1.71) 0.83 (0.48, 1.53) 0.145 (-0.018, 0.309) 0.081 0.245 (-0.030, 0.520) 0.081 Third stage (h) 0.09 (0.07, 0.15) 0.08 (0.07, 0.13) -0.031 (-0.112, 0.049) 0.446 -0.017 (-0.153, 0.120) 0.811 Total labor duration (h) 8.99 (6.23, 12.47) 9.67 (6.00, 14.00) -0.652 (-1.576, 0.272) 0.166 -0.086 (-1.993, 0.938) 0.914 Umbilical vein oxytocin injection (%) 11 (6.6) 32 (9.8) 0.654 (0.321, 1.333) 0.243 0.589 (0.180, 1.922) 0.380 Manual removal of placenta (%) 6 (3.6) 26 (8.0) 0.434 (0.175, 1.077) 0.072 0.508 (0.110, 2.336) 0.384 Abbreviations: OR: Odds ratio; aOR: Adjusted odds ratio; B: Regression coefficient; aB: Adjusted regression coefficient. Confounding factors adjusted for: gestational hyperglycemia, induction of labor, and use of ASA, immunosuppressants, and P4. Maternal and neonatal outcomes in LMWH and control groups undergoing trial of vaginal delivery by onset of labor A subgroup analysis was conducted among parturients who underwent trial of vaginal delivery based on the onset of labor (induced vs. spontaneous). Among women who received LMWH during pregnancy, those who underwent labor induction had significantly greater gestational age at delivery and higher neonatal birth weight compared to those with spontaneous labor onset ( P 0.05). In the induced labor subgroup, the use of P4, ASA, and immunosuppressants was significantly more common among women who received LMWH than among those who did not ( P 0.05). Similarly, among women with spontaneous labor onset, those who had received LMWH exhibited significantly higher rates of gestational hyperglycemia and more frequent use of P4, ASA, and immunosuppressants compared with those in the control group ( P 0.05) (Table 6 ). Table 6 Baseline Clinical Characteristics of Parturients Undergoing Trial of Vaginal Delivery by Onset of Labor LMWH Induction Group (n = 92) LMWH Spontaneous Labor Group (n = 89) Non-LMWH Induction Group (n = 133) Non-LMWH Spontaneous Labor Group (n = 241) P a P b P c Age (years) 30.79 ± 4.51 30.45 ± 3.73 30.89 ± 4.34 30.51 ± 4.15 0.577 0.866 0.910 BMI (kg/m^2) 26.53 ± 3.00 26.02 ± 3.42 26.08 ± 3.37 26.05 ± 3.41 0.290 0.305 0.949 Gravidity 2 (1, 3) 2 (2, 4) 2 (1, 3) 2 (1, 3) 0.276 0.170 0.245 Parity 0 (0, 1) 0 (0, 1) 0 (0, 1) 0 (0, 1) 0.244 0.623 0.143 ART (%) 12 (13.0) 11 (12.4) 28 (21.1) 26 (10.8) 0.890 0.122 0.688 Gestational age (weeks) 38.79 ± 1.08 38.17 ± 1.56 38.75 ± 1.62 38.44 ± 2.01 0.002 0.830 0.244 Gestational diabetes (%) 21 (22.8) 19 (21.3) 32 (24.1) 25 (10.4) 0.811 0.830 0.009 HDP (%) 7 (7.6) 9 (10.1) 9 (6.8) 18 (7.5) 0.553 0.809 0.437 ICP (%) 1 (1.1) 1 (1.1) 3 (2.3) 0 (0.0) 1.000 0.889 0.270 Gestational hypothyroidism (%) 13 (14.1) 11 (12.4) 18 (13.5) 16 (6.6) 0.725 0.898 0.092 Medication Use (%) P4 26 (28.3) 24 (27.0) 11 (8.3) 6 (2.5) 0.846 <0.001 <0.001 ASA 67 (72.8) 59 (66.3) 3 (2.3) 1 (0.4) 0.339 <0.001 <0.001 Immunosup-pressants 62 (67.2) 49 (55.1) 2 (1.5) 1 (0.4) 0.088 < 0.001 < 0.001 Labor Induction Methods (%) Cervical balloon 41 (44.6) - 34 (31.5) - - - - Oxytocin 40 (43.5) - 62 (57.4) - - - - Artificial rupture of membranes 11 (12.0) - 12 (11.1) - - - - Birth weight (g) 3239.67 ± 382.609 3107.53 ± 337.969 3188.98 ± 452.82 3182.20 ± 484.04 0.015 0.381 0.181 Abbreviations: BMI, body mass index; ART, assisted reproductive technology; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis of pregnancy; P4, progesterone; ASA, acetylsalicylic acid. P a: Comparison between observation-induced and observation-spontaneous groups; P b: Comparison between observation-induced and control-induced groups; P c: Comparison between observation-spontaneous and control-spontaneous groups In women receiving LMWH during pregnancy, pregnancy outcomes did not differ significantly between induced and spontaneous labor after adjusting for delivery gestational age and birth weight ( P > 0.05). Among women undergoing induced trial of vaginal delivery, maternal and neonatal outcomes did not differ significantly between the LMWH and control groups after adjusting for the use of P4, ASA, and immunosuppressants ( P > 0.05). However, among women with spontaneous labor onset, LMWH use was associated with a significantly increased risk of PPH overall and a significantly greater intrapartum blood loss in those who achieved vaginal delivery after adjustment for gestational hyperglycemia and the use of P4, ASA, and immunosuppressants ( P 0.05) (Table 7 ). Table 7 Maternal and Neonatal Outcomes in LMWH and Reference groups Undergoing Trial of Vaginal Delivery by Onset of Labor LMWH Induction Group (n = 92) LMWH Spontaneous Labor Group (n = 89) Non-LMWH Induction Group (n = 133) Non-LMWH Spontaneous Labor Group (n = 241) Pa Pb Pc Maternal PROM (%) 19 (20.7) 21 (23.6) 52 (39.1) 39 (16.2) 0.978 0.678 0.399 PPH (%) 8 (8.7) 7 (7.9) 12 (9.0) 16 (6.6) 0.254 0.881 0.049 Uterine atony (%) 7 (7.6) 4 (4.5) 11 (8.3) 15 (6.2) - - - Placental abnormalities (%) 1 (1.1) 2 (2.2) 0 (0.0) 0 (0.0) - - - Perineal laceration (%) 0 (0.0) 1 (1.1) 1 (0.8) 1 (0.4) - - - Emergency cesarean section (%) 10 (10.9) 5 (5.6) 25 (18.8) 22 (9.1) 0.344 0.116 0.237 Intrapartum blood loss (ml) 300 (300, 300) 300 (300, 350) 300 (300, 400) 300 (300, 400) 0.613 0.548 0.977 Vaginal delivery (%) 82 (89.1) 84 (94.4) 108 (81.2) 219 (89.9) 0.344 0.116 0.237 Vaginal delivery blood loss (ml) 100 (100, 100) 100 (100, 200) 125 (100, 200) 100 (100, 200) 0.658 0.232 0.032 Blood loss 2 hours postpartum (ml) 70 (50, 100) 60 (50, 90) 60 (50, 100) 70 (50, 100) 0.666 0.675 0.072 Placental adhesion (%) 3 (3.3) 3 (3.4) 6 (4.5) 10 (4.1) 0.598 0.717 0.688 Placenta accreta (%) 1 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) 0.997 0.996 - Placental abruption (%) 0 (0.0) 3 (3.4) 0 (0.0) 0 (0.0) 0.997 - 0.994 Oligohydramnios (%) 5 (5.4) 2 (2.2) 14 (10.5) 6 (2.5) 0.468 0.310 0.315 Neonatal 1-minute Apgar score 10 (10, 10) 10 (10, 10) 10 (10, 10) 10 (10, 10) 0.272 0.634 0.317 5-minute Apgar score 10 (10, 10) 10 (10, 10) 10 (10, 10) 10 (10, 10) 0.438 0.673 0.233 Abbreviations: PROM, premature rupture of membrane; PPH, postpartum hemorrhage. P a: Comparison between LMWH induction and LMWH spontaneous labor groups, adjusted for gestational age and neonatal birth weight; P b: Comparison between LMWH induction and control induction groups, adjusted for use of P4, ASA, and immunosuppressants; P c: Comparison between LMWH spontaneous labor and control spontaneous labor groups, adjusted for gestational diabetes, and use of P4, ASA, and immunosuppressants. Intrapartum interventions and labor duration in LMWH and control groups undergoing vaginal delivery by onset of labor In women receiving LMWH during pregnancy, those who underwent labor induction had significantly higher utilization rates of epidural analgesia and oxytocin augmentation compared to those with spontaneous labor onset, after adjusting for gestational age at delivery and neonatal birth weight ( P < 0.05). Notably, LMWH-exposed women undergoing induction demonstrated a increasing risk of episiotomy compared to non-exposed controls, independent of P4, aspirin, or immunosuppressant use ( P 0.05). In women with spontaneous labor onset, LMWH exposure was independently associated with a higher likelihood of instrumental delivery after controlling for gestational hyperglycemia and the use of P4, ASA, and immunosuppressants ( P 0.05) (Table 8 ). Table 8 Intrapartum Interventions and Labor Duration in LMWH and Reference Groups Undergoing Vaginal Delivery by Onset of Labor LMWH Induction Group (n = 82) LMWH Spontaneous Labor Group (n = 84) Non-LMWH Induction Group (n = 108) Non-LMWH Spontaneous Labor Group (n = 219) Pa Pb Pc Forceps-assisted delivery (%) 4 (4.9) 8 (9.5) 6 (5.6) 9 (4.1) 0.253 0.430 0.031 Episiotomy (%) 13 (15.9) 15 (17.9) 12 (11.1) 22 (10.0) 0.477 0.009 0.284 Intravenous phloroglucinol (%) 11 (13.4) 8 (9.5) 26 (24.1) 23 (10.5) 0.893 0.111 0.383 Epidural analgesia (%) 75 (91.5) 67 (79.8) 102 (94.4) 182 (83.1) 0.029 0.553 0.483 Oxytocin infusion (%) 70 (85.4) 40 (53.6) 84 (77.8) 75 (34.2) 0.000 0.173 0.163 Artificial rupture of membranes (%) 0 (0.0) 17 (20.2) 3 (2.8) 37 (16.9) 0.996 0.998 0.226 First stage (h) 6.92 (5.40, 10.71) 8.00 (5.25, 11.13) 7.83 (4.71, 11.23) 9.00 (5.33, 13.25) 0.167 0.746 0.866 Second stage (h) 0.97 (0.56, 1.69) 0.94 (0.47, 1.75) 0.99 (0.57, 1.72) 0.80 (0.42, 1.43) 0.917 0.495 0.113 Third stage (h) 0.10 (0.07, 0.17) 0.08 (0.07, 0.15) 0.09 (0.07, 0.17) 0.08 (0.07, 0.13) 0.452 0.989 0.867 Total labor duration (h) 8.57 (6.23, 12.17) 9.22 (6.10, 12.94) 9.38 (5.93, 12.54) 9.88 (6.17, 14.67) 0.258 0.841 0.921 Umbilical vein oxytocin injection (%) 5 (6.1) 6 (7.1) 13 (12.0) 19 (8.7) 0.884 0.729 0.475 Manual removal of placenta (%) 4 (4.9) 2 (2.4) 10 (9.3) 16 (7.3) 0.513 0.396 0.853 P a: Comparison between LMWH induction and LMWH spontaneous labor groups, adjusted for gestational age and neonatal birth weight; P b: Comparison between LMWH induction and control induction groups, adjusted for use of P4, ASA, and immunosuppressants; P c: Comparison between LMWH spontaneous labor and control spontaneous labor groups, adjusted for gestational diabetes, and use of P4, ASA, and immunosuppressants. DISCUSSION Main findings This study found that long-term LMWH use during pregnancy was associated with a reduced likelihood of cesarean delivery but an elevated risk of PPH compared to non-users. Among women who delivered vaginally, those receiving LMWH had a lower rate of intrapartum cesarean conversion but experienced greater blood loss and higher utilization of obstetric interventions such as instrumental delivery and episiotomy. Notably, in spontaneous labors, LMWH use was linked to an increased risk of hemorrhage, underscoring the need for careful monitoring during delivery. Importantly, no significant differences were observed in other maternal or neonatal outcomes, including placental complications or neonatal well-being. These findings suggest that while LMWH may support vaginal birth, it requires heightened vigilance for bleeding risks and individualized intrapartum care to optimize outcomes. Strengths and limitations The major strength of this study lies in its focused investigation of pregnant women requiring LMWH - a population with high rates of labor induction. We systematically examined their labor characteristics, intrapartum interventions, and delivery outcomes through methodologically robust subgroup analyses stratified by mode of labor onset (induced versus spontaneous). This approach yielded clinically important insights into how LMWH exposure interacts with different labor patterns. Furthermore, our analysis accounted for key confounding variables, including concomitant medication use (such as ASA and P4), enhancing the reliability of our findings. Nevertheless, several limitations should be acknowledged. First, as a retrospective study, it is susceptible to potential biases, including incomplete documentation and variability in clinical practice over time, as well as the limited exposure detail regarding LMWH dosage, formulation, and last administration timing. Second, while we adjusted for key confounders, residual confounding from unmeasured factors such as patient preferences or nuanced clinical management cannot be excluded. In our cohort, LMWH regimens were frequently adjusted during pregnancy based on maternal weight, trimester-specific risk assessments, and evolving clinical conditions, resulting in substantial intra-individual dose variability. Therefore, although LMWH dosage is clinically relevant, we did not perform dosage stratification in our analysis, nor did we specifically address the outcomes associated with low-dose, intermediate-dose, or high-dose LMWH treatment at the time of delivery. Finally, the relatively limited sample size restricted our ability to incorporate all potentially relevant variables into the multivariable regression models. Future research should prioritize prospective, multicenter studies with standardized protocols to validate our findings. Additionally, mechanistic studies exploring the biological effects of LMWH on uterine contractility and cervical remodeling could provide deeper insights into its role in labor progression. Interpretation The use of LMWH during pregnancy raises significant clinical concerns regarding its potential to increase the risk of PPH and influence the mode of delivery; however, the existing evidence on these outcomes remains conflicting. Galambosi et al. [ 4 ] discovered no substantial difference in the incidence of PPH between the LMWH-treated group and the control group. In contrast, a systematic review and meta-analysis [ 9 ] reported that the utilization of LMWH during pregnancy notably elevated the risk of PPH. Nevertheless, it did not have a significant impact on the average blood loss or transfusion requirements when compared to the control group. This suggests that although LMWH may increase the likelihood of bleeding events, its partial anticoagulant effect does not significantly compromise overall hemostatic function. Our stratified analysis indicated that LMWH was linked to a higher risk of PPH and greater blood loss, particularly in spontaneous labors. This may be attributed to the combined impacts of physiological uterine contractions, trauma associated with vaginal delivery, and the anticoagulant characteristics of LMWH. Nevertheless, this association vanished in induced labors, potentially due to the fact that induction protocols alleviated the bleeding risk. When examining delivery mode, Donnelly et al. [ 10 ] reported higher induction rates without an increased CS rate with LMWH. Our study, however, found a reduced intrapartum CS rate during labor trials with LMWH, which is consistent with the findings of Ekman - Ordeberg et al. [ 6 ], contributing to a lower overall CS rate. Nevertheless, it contrasts with the results of Andersen et al. [ 21 ], who reported a higher CS rate attributed to maternal risk factors. This contrast raises the question of whether this reduction reflects differences in physician management rather than a pharmacological effect of LMWH. Specifically, in high - risk pregnancies requiring anticoagulation, clinicians may adopt a more conservative or expectant approach to labor, potentially avoiding interventions that could lead to a CS. However, after adjusting for maternal factors (age, BMI), complications (HDP, GDM), medications, and labor onset stratification, this association became non-significant in our study. This suggests that the observed difference is more likely attributable to underlying clinical characteristics and structured management of comorbidities rather than to LMWH itself. Therefore, while vigilant monitoring for hemorrhage remains essential, comprehensive management of maternal comorbidities appears to be the key factor in mitigating any apparent impact of LMWH on CS rates. Placental adhesion/accreta and abruption are major contributors to PPH and cesarean delivery, yet their associations with LMWH use differ significantly. Our study provides the first comprehensive clinical evidence that LMWH exposure is not significantly associated with retained placenta or histologically confirmed accreta after adjusting for confounders such as concomitant medications, maternal characteristics, and delivery methods. Mechanistically, LMWH promotes trophoblast proliferation, invasiveness, hCG secretion, and modulates angiogenesis and inflammation, theoretically affecting placental adhesion by altering trophoblast-endometrial interactions [ 22 – 24 ]. However, our data do not support a causal link with placental adhesion disorders. This aligns with the pharmacological profile of LMWH, which appears insufficient to disrupt normal placental separation in vivo. In contrast, LMWH is associated with a reduced incidence of placental abruption in high-risk pregnancies. Studies by Gris et al. [ 25 ] and Kupferminc et al. [ 26 ] demonstrated that LMWH use was linked to a lower recurrence of abruption in women with thrombophilia or prior vascular complications, likely by preventing microthrombi formation and improving placental perfusion. Meta-analyses [ 27 ] and our data confirm that LMWH does not increase abruption risk in general obstetric populations. These observations highlight that the association between LMWH and abruption may be context-dependent. It appears to have little effect on placental separation under normal conditions, but it may mitigate thrombotic processes that contribute to premature detachment in at-risk women. Consequently, LMWH neither exacerbates adhesion-related PPH nor abruption-related PPH, and may even lower emergency cesarean delivery rates in high-risk pregnancies by reducing abruption risk. The influence of LMWH on labor duration remains debated, with studies reporting conflicting results[ 5 – 7 ]. Our data showed no significant effect of LMWH on any labor stage after adjusting for maternal, obstetric, and pharmacological factors. Subgroup analyses by labor onset mode further supported this null association. Inconsistencies across studies may stem from population heterogeneity, LMWH regimen variations, or differences in labor management. Likewise, no significant associations were found between LMWH use and oxytocin, AROM, or phloroglucinol administration, indicating LMWH does not substantially affect labor progression or augmentation needs. Moreover, despite theoretical concerns about epidural hematoma, LMWH exposure did not reduce epidural rates significantly—likely due to strict protocol adherence, including timely discontinuation before delivery. Labor induction may facilitate better timing of LMWH cessation compared to spontaneous labor [ 28 , 29 ]. Overall, with standard guidelines, LMWH does not clearly influence key intrapartum interventions. Our study provides novel insights into the potential impact of antenatal LMWH on intrapartum interventions, particularly forceps-assisted delivery and episiotomy. Prior research reported no significant difference in forceps delivery rates among women with pre-pregnancy dalteparin exposure[ 6 ]. In contrast, our findings demonstrate that current antenatal LMWH administration is associated with elevated risks of both interventions. The observed association may arise from the interplay of pharmacological and pathophysiological factors. LMWH's anticoagulant properties could influence perineal tissue integrity, increasing the likelihood of episiotomy[ 30 ]. A more direct explanation may be found in clinical decision-making. Caregivers, perceiving LMWH prophylaxis (either due to the medication itself or the underlying maternal condition such as thrombophilia or placental insufficiency) as a risk factor, may opt for a more expedient delivery. This approach could involve a higher likelihood of performing an episiotomy to expedite the second stage of labor or a greater propensity for instrumental delivery to avoid prolonged labor and potential fetal compromise in at-risk pregnancies[ 31 ]. Notably, subgroup analyses showed that LMWH-exposed women undergoing labor induction required episiotomies more frequently, while those experiencing spontaneous labor onset had higher rates of forceps-assisted deliveries. These findings underscore that the mode of labor initiation may modulate LMWH's influence on delivery outcomes. Multiple studies, including ours, have demonstrated that LMWH does not adversely affect key neonatal outcomes, such as SGA, macrosomia, oligohydramnios, or PROM [ 4 , 6 , 10 , 32 ]. Some studies have suggested that LMWH treatment may increase fetal birth weight, particularly in high-risk populations such as pregnancies with fetal growth restriction[ 33 – 35 ]. However, this effect does not appear to increase the risk of macrosomia after adjusting for maternal age, BMI, and gestational age at delivery[ 36 ]. Importantly, LMWH does not cross the placenta, supporting its established fetal safety profile. Overall, the accumulated evidence strongly supports the neonatal safety profile of LMWH. In conclusion, our study demonstrates that while long-term LMWH use during pregnancy is associated with reduced cesarean delivery rates, it requires careful monitoring due to increased PPH risk, particularly in spontaneous labors. Importantly, LMWH shows no adverse effects on placental adhesion disorders or key neonatal outcomes. Importantly, the observed increases in obstetric interventions (forceps delivery and episiotomy) appear mediated by a combination of pharmacological properties and underlying maternal risk factors rather than direct LMWH effects. Collectively, our findings support LMWH's overall safety in pregnancy when managed appropriately, while highlighting critical areas for optimized clinical practice and future research to further refine risk-benefit assessments in this population. Abbreviations APS Antiphospholipid Syndrome ART Assisted Reproductive Technology ASA Acetylsalicylic Acid BMI Body Mass Index HDP Hypertensive Disorders of Pregnancy ICP Intrahepatic Cholestasis of Pregnancy LMWH Low molecular weight heparin PSM Propensity Score Matching PPH Postpartum hemorrhage P4 Progesterone RSA Recurrent Spontaneous Abortion SGA Small for Gestational Age VTE Venous Thromboembolism Declarations Ethics approval and consent to participate: Ethical approval was obtained by the Institutional Review Board of the the Second Affiliated Hospital of Wenzhou Medical University (Approval No. 2024-K-111-01), and conducted in accordance with the principles of the Declaration of Helsinki. Given the retrospective nature of the study and the use of anonymized clinical data, the requirement for informed consent was waived by the Institutional Review Board. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This work was supported by Zhejiang province medical science and technology of China (grant number 2025KY1010) and Wenzhou Municipal Science and Technology Bureau (grant number GY20250286). Authors' contributions: Kechen Li and Li Zhou contributed to the design of the work and collected the data. Jieni Zou revised the manuscript and organized the data. Yujia Zhou drafted the article. Zhaoxia Huang collected the data. Ke Dong and Ying Hua supervised the analyses and revised the manuscript. All authors have contributed to the design of the study, drafting the paper and revising it critically for important intellectual content and approved it for publication. Acknowledgements: The authors would like to thank all women who gave up their time to participate in this study. References Saad A, Safarzadeh M, Shepherd M. Anticoagulation Regimens in Pregnancy. Obstetrics and Gynecology Clinics of North America. 2023;50:241–9. https://doi.org/10.1016/j.ogc.2022.10.010 Abbattista M, Capecchi M, Gianniello F, Artoni A, Bucciarelli P, Ciavarella A, et al. A retrospective study on the use of low-molecular-weight heparin for prevention of pregnancy-related recurrent venous thromboembolism and obstetrical complications. Blood Coagul Fibrinolysis. 2022. https://doi.org/10.1097/MBC.0000000000001190 . D’Ippolito S, Ortiz AS, Veglia M, Tersigni C, Di Simone N. Low Molecular Weight Heparin in Obstetric Care: A Review of the Literature. Reprod Sci. 2011;18:602–13. https://doi.org/10.1177/1933719111404612 . Galambosi PJ, Kaaja RJ, Stefanovic V, Ulander V-M. Safety of low-molecular-weight heparin during pregnancy: a retrospective controlled cohort study. Eur J Obstet Gynecol Reproductive Biology. 2012;163:154–9. https://doi.org/10.1016/j.ejogrb.2012.05.010 . Ekman-Ordeberg G, Hellgren M, Åkerud A, Andersson E, Dubicke A, Sennström M, et al. Low molecular weight heparin stimulates myometrial contractility and cervical remodeling in vitro. Acta Obstet Gynecol Scand. 2009;88:984–9. https://doi.org/10.1080/00016340903176818 . Ekman-Ordeberg G, Åkerud A, Dubicke A, Malmström A, Hellgren M. Does low molecular weight heparin shorten term labor? Acta Obstet Gynecol Scand. 2010;89:147–50. https://doi.org/10.3109/00016340903294272 . Sandström A, Cnattingius S, Wikström A-K, Stephansson O, Iliadou AN. Does Use of Low-Molecular-Weight Heparin during Pregnancy Influence the Risk of Prolonged Labor: A Population-Based Cohort Study. PLoS ONE. 2015;10:e0140422. https://doi.org/10.1371/journal.pone.0140422 . Knol HM, Schultinge L, Veeger NJGM, Kluin-Nelemans HC, Erwich JJHM, Meijer K. The risk of postpartum hemorrhage in women using high dose of low-molecular-weight heparins during pregnancy. Thromb Res. 2012;130:334–8. https://doi.org/10.1016/j.thromres.2012.03.007 . Sirico A, Saccone G, Maruotti GM, Grandone E, Sarno L, Berghella V, et al. Low molecular weight heparin use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis. J Maternal-Fetal Neonatal Med. 2019;32:1893–900. https://doi.org/10.1080/14767058.2017.1419179 . Donnelly J, Byrne J, Murphy K, McAuliffe F. Obstetric outcome with low molecular weight heparin therapy during pregnancy. Ir Med J. 2012;105:27–9. Lester W, Walker N, Bhatia K, Ciantar E, Banerjee A, Trinder J, et al. British Society for Haematology guideline for anticoagulant management of pregnant individuals with mechanical heart valves. Br J Haematol. 2023;202:465–78. https://doi.org/10.1111/bjh.18781 . ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstetrics & Gynecology. 2019;133:e164–73. https://doi.org/10.1097/AOG.0000000000003074 American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018;132:e1–17. https://doi.org/10.1097/AOG.0000000000002706 . Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Intl J Gynecol Obste. 2022;157:3–50. https://doi.org/10.1002/ijgo.14116 . Favilli A, Tosto V, Ceccobelli M, Parazzini F, Franchi M, Bini V, et al. Risk factors for non-adherent retained placenta after vaginal delivery: a systematic review. BMC Pregnancy Childbirth. 2021;21:268. https://doi.org/10.1186/s12884-021-03721-9 . Donovan BM, Shainker SA, Placenta Accreta Spectrum. NeoReviews. 2021;22:e722–33. https://doi.org/10.1542/neo.22-11-e722 . Zilberman Sharon N, Pekar-Zlotin M, Kugler N, Accart Z, Nimrodi M, Melcer Y, et al. Oligohydramnios: how severe is severe? J Maternal-Fetal Neonatal Med. 2022;35:5754–60. https://doi.org/10.1080/14767058.2021.1892068 . Prelabor Rupture of Membranes. ACOG Practice Bulletin, Number 217. Obstet Gynecol. 2020;135:e80–97. https://doi.org/10.1097/AOG.0000000000003700 . Nguefack Tchente C, Njamen Nana T, Nkemtendong Tolefac P, Hongieh Abanda M, Endomba Angong FT, Tamambang RF, et al. Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa. Pan Afr Med J. 2018;30. https://doi.org/10.11604/pamj.2018.30.17.14728 . First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstet Gynecol. 2024;143:144–62. https://doi.org/10.1097/AOG.0000000000005447 Andersen AS, Berthelsen JG, Bergholt T. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin. Acta Obstet Gynecol Scand. 2010;89:15–21. https://doi.org/10.3109/00016340903370098 . Oberkersch R, Attorresi AI, Calabrese GC. Low-molecular-weight heparin inhibition in classical complement activaton pathway during pregnancy. Thromb Res. 2010;125:e240–5. https://doi.org/10.1016/j.thromres.2009.11.030 . Sobel ML, Kingdom J, Drewlo S. Angiogenic Response of Placental Villi to Heparin. Obstet Gynecol. 2011;117:1375–83. https://doi.org/10.1097/AOG.0b013e31821b5384 . Chen Y, Wu X-X, Tan J, Liu M, Liu Y, Zhang J-P. Effects of low molecular weight heparin and heparin-binding epidermal growth factor on human trophoblast in first trimester. Fertil Steril. 2012;97:764–70. https://doi.org/10.1016/j.fertnstert.2011.12.002 . Gris J-C, Chauleur C, Faillie J-L, Baer G, Marès P, Fabbro-Peray P, et al. Enoxaparin for the secondary prevention of placental vascular complications in women with abruptio placentae: The pilot randomised controlled NOH-AP trial. Thromb Haemost. 2010;104:771–9. https://doi.org/10.1160/TH10-03-0167 . Kupferminc M, Rimon E, Many A, Maslovitz S, Lessing JB, Gamzu R. Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia. Blood Coagul Fibrinolysis. 2011;22:123–6. https://doi.org/10.1097/MBC.0b013e328343315c . Rodger M, De Vries JI, Rey E, Gris J-CJ, Martinelli I, Schleussner E, et al. Low Molecular Weight Heparin for Prevention of Placenta-Mediated Pregnancy Complications: An Individual Patient Data Meta-Analysis. Blood. 2015;126:890–890. https://doi.org/10.1182/blood.V126.23.890.890 . Rottenstreich A, Zacks N, Kleinstern G, Levin G, Sompolinsky Y, Mankuta D, et al. Planned induction versus spontaneous delivery among women using prophylactic anticoagulation therapy: a retrospective study. BJOG. 2020;127:1241–8. https://doi.org/10.1111/1471-0528.16247 . Roueli A, Cesario E, Amsellem J, Agman A, Vauthier-Brouzes D, Nizard J. Is a therapeutic anticoagulation window needed for delivery when using prophylactic low molecular weight heparin during pregnancy? A retrospective monocentric study. Eur J Obstet Gynecol Reproductive Biology. 2017;215:118–23. https://doi.org/10.1016/j.ejogrb.2017.05.019 . Laine K, Yli BM, Cole V, Schwarz C, Kwee A, Ayres-de-Campos D, et al. European guidelines on perinatal care- Peripartum care Episiotomy. J Maternal-Fetal Neonatal Med. 2022;35:8797–802. https://doi.org/10.1080/14767058.2021.2005022 . Verma GL, Spalding JJ, Wilkinson MD, Hofmeyr GJ, Vannevel V, O’Mahony F. Instruments for assisted vaginal birth. Cochrane Database Syst Reviews. 2021;2021. https://doi.org/10.1002/14651858.CD005455.pub3 Deruelle P, Denervaud M, Hachulla E, Ducloy-Bouthors A-S, Valat A-S, Puech F, et al. Use of low-molecular-weight heparin from the first trimester of pregnancy: A retrospective study of 111 consecutive pregnancies. Eur J Obstet Gynecol Reproductive Biology. 2006;127:73–8. https://doi.org/10.1016/j.ejogrb.2005.09.010 . Xu J, Tang Y, Peng B, Zhang W, Wang X. Effect of low-molecular‐weight heparin on placenta‐mediated fetal growth restriction in a tertiary referral hospital: A 7‐year retrospective cohort study. Intl J Gynecol Obste. 2024;165:220–8. https://doi.org/10.1002/ijgo.15098 . Comparison of Low Molecular Weight Heparin. Used alone or Combined with Aspirin in the Treatment of Fetal Growth Restriction. J Coll Physicians Surg Pak. 2022;32:1228–9. https://doi.org/10.29271/jcpsp.2022.09.1228 . Bettiol A, Avagliano L, Lombardi N, Crescioli G, Emmi G, Urban ML, et al. Pharmacological Interventions for the Prevention of Fetal Growth Restriction: A Systematic Review and Network Meta-Analysis. Clin Pharma Ther. 2021;110:189–99. https://doi.org/10.1002/cpt.2164 . Lowry DE, Corsi DJ, White RR, Guo M, Lanes A, Smith G, et al. Association between prophylactic low-molecular‐weight heparin use in pregnancy and macrosomia: analysis of the Ottawa and Kingston birth cohort. J Thromb Haemost. 2019;17:345–9. https://doi.org/10.1111/jth.14358 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8700142","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592383719,"identity":"f44e02a8-aca9-4207-8454-7ceac547233a","order_by":0,"name":"Kechen Li","email":"","orcid":"","institution":"Second Affiliated Hospital \u0026 Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kechen","middleName":"","lastName":"Li","suffix":""},{"id":592383721,"identity":"8ccc0957-4b90-41a3-9fa9-396dc7a6abbb","order_by":1,"name":"Li Zhou","email":"","orcid":"","institution":"Second Affiliated Hospital \u0026 Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhou","suffix":""},{"id":592383722,"identity":"c2d61774-6127-4964-9cbe-54f00db1d957","order_by":2,"name":"Jieni Zou","email":"","orcid":"","institution":"Second Affiliated Hospital \u0026 Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jieni","middleName":"","lastName":"Zou","suffix":""},{"id":592383726,"identity":"0b84f715-914b-4446-95d2-dff818d2571a","order_by":3,"name":"Zhaoxia Huang","email":"","orcid":"","institution":"Second Affiliated Hospital \u0026 Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhaoxia","middleName":"","lastName":"Huang","suffix":""},{"id":592383731,"identity":"25e04577-81b2-4cc6-bac4-a714dba487eb","order_by":4,"name":"Ke Dong","email":"","orcid":"","institution":"Second Affiliated Hospital \u0026 Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Dong","suffix":""},{"id":592383736,"identity":"cb879d5d-a196-4b85-b1fd-b3de3c65ad70","order_by":5,"name":"Yujia Zhou","email":"","orcid":"","institution":"Wenzhou City People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yujia","middleName":"","lastName":"Zhou","suffix":""},{"id":592383738,"identity":"ad1bf788-a209-4ad8-afe7-4a4ccead7e15","order_by":6,"name":"Ying Hua","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYFACxgcMjA0MPGzM/A8fJFTYEKOF2QCkRYafnYfZ4MGZNOK12Ej287BJPmw7RFiDwfnDjI95dxzmMTjMe6wige0AA397dwJ+LQcOMxvzngFp4Uu7kcBzh0HizNkNeLWYHew/Js3bBtLCYHYjQeIZg4FELgEth5nZf8O0FCQAScJajjGzMYO0SDbzmDEkJBChxf4MM7Pk3LZ0Hn5mtmSJhANpPAT9Itl/mPHD2zZrezb+wwc//vxnI8ff3otfCwgw8TA0wzk8BJWDAOMPhjqiFI6CUTAKRsEIBQAmSkjWkql2DgAAAABJRU5ErkJggg==","orcid":"","institution":"Second Affiliated Hospital \u0026 Yuying Children's Hospital of Wenzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Ying","middleName":"","lastName":"Hua","suffix":""}],"badges":[],"createdAt":"2026-01-26 12:23:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8700142/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8700142/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102893325,"identity":"656f5fd2-d919-4b73-99b5-d686e7a99c0b","added_by":"auto","created_at":"2026-02-18 05:42:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54847,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8700142/v1/7678451b8d74e70706eaac4d.png"},{"id":103049601,"identity":"359cc3a9-aa57-4c3e-ab6a-5f9210f73d56","added_by":"auto","created_at":"2026-02-20 07:43:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1999576,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8700142/v1/d14c29a3-e73c-4c6b-9ad5-5b29b588c34c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Labor characteristics and Perinatal Outcomes Associated with Low Molecular Weight Heparin Therapy: Differential Effects in Induced versus Spontaneous Labor","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLow molecular weight heparin (LMWH) is a well-established anticoagulant for venous thromboembolism (VTE) prophylaxis and treatment during pregnancy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Beyond its fundamental anticoagulant activity, LMWH possesses unique biological properties including immunomodulatory effects (through complement inhibition and cytokine regulation), the ability to enhance trophoblast invasion, and improvement of uteroplacental circulation[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These mechanisms have contributed to its increasing use in selected high-risk pregnancies, such as those with antiphospholipid syndrome (APS), recurrent spontaneous abortion (RSA), or assisted reproductive technology (ART) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Its favorable safety profile, characterized by minimal placental transfer and negligible excretion into breast milk, further supports its use during pregnancy and lactation[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite limited evidence supporting its efficacy for placenta-mediated complications such as preeclampsia and fetal growth restriction, LMWH is frequently employed in clinical practice, often based on physician preference. Furthermore, it is well-known that quite many infertility clinics disregards the official recommendations from official societies and still use a lot of LMWH despite the lack of evidence of its effects. Given its widespread clinical application, this study was conducted to evaluate the effects of LMWH on labor progression and delivery outcomes.\u003c/p\u003e \u003cp\u003eIn vitro studies suggest that LMWH may augment labor progression through dual pathways: potentiating uterine smooth muscle contractility via specific signaling cascades and accelerating cervical maturation by stimulating interleukin-8 (IL-8) secretion from cervical fibroblasts[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although some clinical reports associate LMWH with shortened first-stage labor[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], others found no significant association after adjusting for confounders[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Similarly, concerns regarding the risk of PPH persist, as the available evidence on the relationship between LMWH and PPH remains controversial[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, LMWH\u0026rsquo;s modulation of trophoblast biology raises unanswered questions about its influence on placental separation disorders (e.g., adhesion/accreta), warranting further investigation.\u003c/p\u003e \u003cp\u003eInduction of labor (IOL) is more commonly carried out in pregnancies that necessitate LMWH therapy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This is mainly because there is a dual requirement to manage the underlying high - risk conditions and to optimize anticoagulation control. According to guideline recommendations, LMWH should be discontinued 24 hours before delivery to minimize bleeding risks[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Planned induction enables precise coordination between the timing of the last anticoagulant dose and the delivery, thus maintaining effective thromboprophylaxis while reducing the risk of hemorrhage. Women were instructed to withhold further self-administered LMWH once labor commenced and were reassessed upon admission. Importantly, no evidence indicates that IOL is superior or safer than spontaneous labor specifically in LMWH-treated women, and both approaches are considered acceptable in current clinical practice. It is crucial to note that IOL itself can have a significant impact on labor outcomes, potentially increasing the rates of cesarean delivery and postpartum hemorrhage (PPH). However, in LMWH-treated pregnancies, the specific effects of induction on labor characteristics, intrapartum interventions, and delivery outcomes remain poorly understood.\u003c/p\u003e \u003cp\u003eTherefore, we conducted a retrospective cohort study to evaluate the clinical characteristics and pregnancy outcomes in LMWH-treated pregnancies. Through stratified analysis by onset of labor (spontaneous versus induced), we specifically examined how labor induction influences labor progression, intrapartum interventions, and delivery outcomes in this population. Our findings provide critical evidence to optimize anticoagulation management and delivery planning in pregnancies requiring LMWH therapy.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and subjects\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study included women who delivered at our hospital between November 2020 and November 2024. Our centre is a tertiary care referral centre with over 10000 deliveries per year. Eligible participants were those with singleton live births at \u0026ge;\u0026thinsp;28 weeks' gestation. Exclusion criteria consisted of: (1) incomplete clinical data; (2) pre-pregnancy BMI\u0026thinsp;\u0026lt;\u0026thinsp;18 kg/m\u0026sup2;; (3) intermittent LMWH use (cumulative duration\u0026thinsp;\u0026lt;\u0026thinsp;20 weeks); (4) cervical insufficiency or genital tract malformations; (5) stillbirth or fetal demise; (6) severe comorbidities (including cardiac disease, thrombocytopenia, hemophilia, liver disease, or kidney disease). The study was approved by the Institutional Review Board (Ethics Approval No.: 2024-K-111-01).\u003c/p\u003e \u003cp\u003eLong-term LMWH users were defined as women receiving LMWH for \u0026ge;\u0026thinsp;20 gestational weeks, verified through prescription records and medication administration logs. Women with \u0026lt;\u0026thinsp;20 cumulative weeks of LMWH exposure were excluded from both groups, as this population was highly heterogeneous, including those receiving short-term LMWH during the first trimester for assisted reproduction, late-pregnancy treatment initiated for elevated D-dimer levels or newly diagnosed fetal growth restriction, or treatment commenced after a late venous thromboembolic event. Excluding these cases allowed us to maintain a homogeneous exposure definition and focus on the effects of long-term, continuous antenatal LMWH use. Participants were categorized into LMWH and non-LMWH (control) groups. All women in the LMWH group received continuous antenatal LMWH therapy rathe r than intermittent or symptom-triggered dosing. In our institution, LMWH is administered using standard pre-filled syringes (4000\u0026ndash;5000 IU per dose), given once or twice daily (qd or bid) according to maternal weight and thrombotic risk. Because dose regimens varied across gestation and could not be reliably categorized into fixed prophylactic or therapeutic groups, LMWH exposure was analyzed as a binary variable (use vs. no use). To control for potential confounders, PSM was performed in a 1:2 ratio using a caliper value of 0.05, matching for maternal age, pre-pregnancy BMI, gravidity, parity, ART use, and gestational age at delivery. Subgroup analyses were subsequently conducted based on labor onset type (induced vs. spontaneous) and delivery mode (vaginal vs. cesarean section (CS)).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eWe systematically collected maternal and neonatal clinical data from electronic medical records, including three key domains: (1) Maternal characteristics-comprising demographic factors (age, gravidity, parity, BMI at delivery, ART use), pre-existing medical conditions (hypothyroidism, pregestational diabetes, chronic hypertension), and pregnancy complications (HDP, hyperglycemia in pregnancy, ICP), and medication exposure (P4, Long-term low-dose aspirin (ASA), Immunosuppressants (e.g., cyclosporine, prednisone)); (2) Labor management details-documenting labor onset type (induced with Bishop score-based methods or spontaneous), delivery mode (vaginal or cesarean), labor durations, and intrapartum interventions (artificial rupture of membranes (AROM), phloroglucinol or oxytocin use, forceps delivery, episiotomy, epidural analgesia, mediolateral episiotomy and manual placental removal) performed according to ACOG guidelines (Vacuum extraction is not routinely practiced at our center and thus was not included as an outcome measure)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; and (3) Outcome measures-evaluating both maternal (PPH, premature rupture of membranes (PROM), placental adhesion, placental abruption, placenta accreta and oligohydramnios) and neonatal outcomes (birth weight, Apgar scores, neonatal asphyxia, macrosomia, and SGA infants).\u003c/p\u003e \u003cp\u003eAdditionally, we collected data on indications for LMWH use, which included: APS, thrombophilia (both inherited and acquired), in vitro fertilization (IVF) cycles, RSA, prior thrombosis history, and other combined or unclassified indications ('other combined indications' referred to cases not meeting the above specific categories). All LMWH-treated patients initiated prophylactic or therapeutic regimens in early pregnancy (\u0026le;\u0026thinsp;12 gestational weeks), maintaining treatment until late pregnancy (minimum duration\u0026thinsp;\u0026ge;\u0026thinsp;20 weeks). Per current guidelines[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], standardized peripartum management ensured LMWH discontinuation\u0026thinsp;\u0026ge;\u0026thinsp;24 hours before delivery. For patients without spontaneous labor onset, delivery was scheduled (either induction or CS) based on obstetric indications or maternal preference to optimize pregnancy outcomes.\u003c/p\u003e\n\u003ch3\u003eRelative definitions\u003c/h3\u003e\n\u003cp\u003eIn this study, cesarean sections were categorized as elective or intrapartum. Elective CS refers to pre-planned surgery based on medical indications (e.g., malpresentation, placenta previa, multiple gestation) or maternal request before the onset of labor. Intrapartum CS refers to emergency conversion to cesarean delivery during a trial of labor due to maternal or fetal complications (e.g., labor arrest, fetal distress, umbilical cord prolapse. PPH was defined using calibrated collection devices and quantitative weighing (weighing of pads and drapes). Definitions followed the ISTH criteria and major obstetric society guidelines: \u0026ge;500 mL for vaginal delivery or \u0026ge;\u0026thinsp;1000 mL for cesarean delivery within 24 hours[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Placental adhesion[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] required surgical confirmation of failed separation, while placenta accreta[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] demanded histopathological evidence of villous myometrial invasion. Quantitative thresholds defined oligohydramnios (amniotic fluid volume \u0026le;\u0026thinsp;300mL)[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. PROM was defined as the spontaneous rupture of fetal membranes before the onset of labor[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLabor induction protocols were Bishop score-dependent: cervical balloon ripening for scores\u0026thinsp;\u0026lt;\u0026thinsp;6 versus oxytocin/artificial rupture of membranes for scores\u0026thinsp;\u0026ge;\u0026thinsp;6. Uterine inertia management included oxytocin augmentation (starting at 2 mU/min, increased by 2 mU/min every 15\u0026ndash;30 minutes until adequate contractions) and amniotomy. Phloroglucinol is thought to facilitate labour by reducing spasms and oedema of the cervix, harmonize shrinkage of the uterus[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Operative vaginal births adhered to FIGO guidelines: forceps application at station\u0026thinsp;\u0026ge;\u0026thinsp;+\u0026thinsp;2 due to fetal compromise or arrest. Episiotomies were selectively performed by senior obstetricians (\u0026ge;\u0026thinsp;10 years\u0026rsquo; experience)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Epidural analgesia utilized 0.1% ropivacaine with 0.33\u0026micro;g/mL sufentanil, initiated after a negative test dose (1% lidocaine). Oxytocin injection via the umbilical vein or manual placental removal was employed in cases of difficult placental delivery to shorten the third stage of labor. Active labour was defined according to contemporary obstetric guidance as cervical dilation\u0026thinsp;\u0026ge;\u0026thinsp;6 cm, and labor stages were timed per FIGO guidelines: first stage (onset to full dilation), second (dilation to delivery), and third (delivery to placental expulsion)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. All timings (labor stages, LMWH discontinuation) followed synchronized electronic clock documentation.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables with normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD), and comparisons between groups were performed using the independent-samples t test. For non-normally distributed continuous variables, data were presented as median and interquartile range (Median [P25, P75]), and the Mann\u0026ndash;Whitney U test (non-parametric test) was used for group comparisons. Categorical variables were expressed as frequencies and percentages (n [%]), and comparisons between groups were conducted using the Pearson chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. All statistical tests were two-tailed, and a \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eTo further investigate the associations between LMWH use during pregnancy and delivery process as well as pregnancy outcomes, logistic regression and linear regression analyses were performed. Both crude and adjusted odds ratios (ORs) or regression coefficients (Beta, B) with their corresponding 95% confidence intervals (95% CIs) were calculated to ensure the robustness of the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, a total of 34,662 parturients delivered at our hospital during the study period, among whom 4,606 women were excluded due to the following reasons: (1) twin or multiple pregnancies (n\u0026thinsp;=\u0026thinsp;1,137); (2) gestational age\u0026thinsp;\u0026lt;\u0026thinsp;28 weeks (n\u0026thinsp;=\u0026thinsp;130); (3) incomplete medical records (n\u0026thinsp;=\u0026thinsp;312); (4) intermittent use of LMWH with a treatment duration of less than 20 weeks (n\u0026thinsp;=\u0026thinsp;1,675); (5) BMI\u0026thinsp;\u0026lt;\u0026thinsp;18 kg/m\u0026sup2; (n\u0026thinsp;=\u0026thinsp;135); (6) reproductive tract malformations (n\u0026thinsp;=\u0026thinsp;393); (7) stillbirth or fetal death (n\u0026thinsp;=\u0026thinsp;6); and (8) severe medical or surgical comorbidities (n\u0026thinsp;=\u0026thinsp;818). The remaining 30,056 eligible parturients were divided into two groups: long-term LMWH users (\u0026ge;\u0026thinsp;20 weeks, n\u0026thinsp;=\u0026thinsp;348) and non-LMWH users (n\u0026thinsp;=\u0026thinsp;29,708). Using PSM at a 1:2 ratio, adjusted for maternal age, BMI at the time of delivery, gravidity, parity, ART, and gestational age at delivery, we established matched cohorts of 348 LMWH users and 696 non-users. After excluding cases involving elective cesarean deliveries (167 in the LMWH group and 322 in the control group), the remaining participants were stratified according to the mode of labor onset. In the LMWH group (n\u0026thinsp;=\u0026thinsp;181), there were 92 induced labors and 89 spontaneous labors, whereas the control group (n\u0026thinsp;=\u0026thinsp;374) included 133 induced labors and 241 spontaneous labors. For each subgroup, we report the numbers of vaginal deliveries and intrapartum cesarean conversions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMaternal and neonatal outcomes in LMWH group and control group\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, there were no significant differences in demographic characteristics or maternal complications\u0026mdash;including gestational hyperglycemia, HDP, and ICP\u0026mdash;or neonatal birth weight between the LMWH group and the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the incidence of gestational hypothyroidism was significantly higher in the LMWH group compared to the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the proportions of concomitant use of P4, ASA, and immunosuppressants were all significantly greater in the LMWH group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The primary indications for LMWH administration during pregnancy were prethrombotic state (50.5%), followed by APS (29.0%) and a history of RSA (4.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the study population (singleton live births\u0026thinsp;\u0026ge;\u0026thinsp;28 weeks, including elective cesarean section)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Group (n\u0026thinsp;=\u0026thinsp;348)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-LMWH Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;696)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.48\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age (week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hyperglycemia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hypothyroidism (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245 (70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppressant (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrethrombotic state\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther causes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: BMI, body mass index; ART, assisted reproductive technology; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis of pregnancy; P4, progesterone; ASA, acetylsalicylic acid; APS, antiphospholipid syndrome; IVF, in vitro fertilization; RSA, recurrent spontaneous abortion.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were no significant differences in major pregnancy outcomes between the LMWH and control groups, including rates of PROM, PPH, placental adhesion, placenta accreta, placental abruption, oligohydramnios, neonatal asphyxia, macrosomia, SGA, and Apgar scores at 1 and 5 minutes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). While initial CS rates appeared comparable between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), multivariate analysis adjusting for hypothyroidism, ASA use, immunosuppressant therapy, and P4 administration revealed the LMWH group had significantly lower odds of total cesarean delivery (aOR\u0026thinsp;=\u0026thinsp;0.617, 95% CI: 0.402\u0026ndash;0.945, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027) but significantly higher odds of PPH (aOR\u0026thinsp;=\u0026thinsp;2.497, 95% CI: 1.084\u0026ndash;5.571, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032). No other statistically significant differences in pregnancy outcomes were observed between groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal and Neonatal Outcomes in LMWH and Reference Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Group (n\u0026thinsp;=\u0026thinsp;348)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-LMWH Group (n\u0026thinsp;=\u0026thinsp;696)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR/B (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaOR/aB (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cesarean section (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e369 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003cp\u003e(0.751, 1.257)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003cp\u003e(0.402, 0.945)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElective cesarean section (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.072\u003c/p\u003e \u003cp\u003e(0.828, 1.387)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003cp\u003e(0.472, 1.108)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003cp\u003e(0.619, 1.211)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.179\u003c/p\u003e \u003cp\u003e(0.689, 2.016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.096\u003c/p\u003e \u003cp\u003e(0.608, 1.976)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.497\u003c/p\u003e \u003cp\u003e(1.084, 5.571)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental adhesion (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003cp\u003e(0.493, 1.540)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003cp\u003e(0.168, 1.204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta accreta (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.435\u003c/p\u003e \u003cp\u003e(0.452, 4.554)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003cp\u003e(0.120, 6.767)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.202\u003c/p\u003e \u003cp\u003e(0.286, 5.058)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.800\u003c/p\u003e \u003cp\u003e(0.370, 21.163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003cp\u003e(0.608, 1.646)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003cp\u003e(0.280, 1.581)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeonatal Outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal birth weight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3142.07\u0026thinsp;\u0026plusmn;\u0026thinsp;425.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3158.58\u0026thinsp;\u0026plusmn;\u0026thinsp;554.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-min Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.839\u003c/p\u003e \u003cp\u003e(9.805, 9.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003cp\u003e(-0.061, 0.134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-min Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.984\u003c/p\u003e \u003cp\u003e(9.946, 10.023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003cp\u003e(-0.104, 0.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal asphyxia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003cp\u003e(0.056, 4.477)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.205\u003c/p\u003e \u003cp\u003e(0.003, 15.999)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrosomia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003cp\u003e(0.370, 1.786)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003cp\u003e(0.284, 3.176)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003cp\u003e(0.424, 1.936)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003cp\u003e(0.118, 1.552)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAbbreviations: OR, Odds Ratio; aOR, Adjusted Odds Ratio; B, Coefficient B; aB, Adjusted Coefficient B; PROM, premature rupture of membrane; PPH, postpartum hemorrhage; SGA, small for gestational age.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eConfounding factors adjusted for: gestational hypothyroidism, use of aspirin (ASA), immunosuppressants, and progesterone (P4).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMaternal and neonatal outcomes in LMWH and control groups undergoing trial of vaginal delivery\u003c/h3\u003e\n\u003cp\u003eA subgroup analysis was performed among parturients who underwent a trial of vaginal delivery. Compared with the control subgroup, the LMWH subgroup exhibited significantly higher rates of gestational hyperglycemia, labor induction, and concomitant use of medications, including P4, ASA and immunosuppressants (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, no statistically significant differences were observed between the two subgroups in terms of maternal age, gravidity, parity, BMI, gestational age at delivery, use of ART, or the incidence of HDP, gestational hypothyroidism, ICP, or neonatal birth weight (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Parturients Undergoing Trial of Vaginal Delivery in LMWH and Reference Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Subgroup\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;181)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-LMWH Subgroup\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;374)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.62\u0026thinsp;\u0026plusmn;\u0026thinsp;4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.958\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m^2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0, 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hyperglycemia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hypothyroidism (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombined medication (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126 (69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInduction of labor (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: BMI, body mass index; ART, assisted reproductive technology; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis of pregnancy; P4, progesterone; ASA, acetylsalicylic acid.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo statistically significant differences were observed between the LMWH and control subgroups in major pregnancy outcomes, including intrapartum CS, elective CS, PROM, PPH, placental adhesion, placenta accreta, placental abruption, oligohydramnios, neonatal asphyxia, macrosomia, SGA, or Apgar scores at 1 and 5 minutes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAfter adjusting for gestational hyperglycemia, induction of labor, and concomitant use of ASA, immunosuppressants, and P4, multivariate regression analysis demonstrated that the LMWH subgroup had a significantly lower risk of intrapartum cesarean delivery compared with the control subgroup (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;0.264; 95% confidence interval [CI]: 0.074\u0026ndash;0.957; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043). Although the incidence of PPH did not differ significantly between groups, the LMWH subgroup experienced significantly greater intrapartum blood loss during vaginal delivery (adjusted β\u0026thinsp;=\u0026thinsp;40.829; 95% CI: 6.135\u0026ndash;75.523; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021). No other significant differences in maternal or neonatal outcomes were detected between the subgroups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal and Neonatal Outcomes in LMWH and Reference Groups Undergoing Trial of Vaginal Delivery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Subgroup\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;181)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-LMWH Subgroup\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;374)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR/B (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaOR/aB (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.882 (0.578, 1.347)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.222 (0.595, 2.508)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.117 (0.581, 2.147)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.206 (0.844, 5.768)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapartum cesarean section (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.629 (0.341, 1.158)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.264 (0.074, 0.957)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapartum blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300 (300, 300)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300 (300, 400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-29.220 (-67.680, 9.241)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-38.479 (-167.391, 90.434)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapartum blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (100, 200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (100, 200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-6.471 (-27.204, 14.261)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.829 (6.135, 75.523)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-hour postpartum blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (50, 90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (50, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.254 (-18.951, 45.458)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.488 (-44.753, 63.728)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental adhesion (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.747 (0.295, 1.995)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.036 (0.226, 4.741)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta accreta (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.712 (0.295, 1.716)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.739 (0.177, 3.090)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeonatal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal birth weight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3174.70\u0026thinsp;\u0026plusmn;\u0026thinsp;366.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3184.61\u0026thinsp;\u0026plusmn;\u0026thinsp;472.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-min Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.001 (-0.068, 0.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.034 (-0.082, 0.150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-min Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021 (-0.049, 0.091)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.008 (-0.113, 0.130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal asphyxia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrosomia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.034 (0.256, 4.181)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.956 (0.098, 9.331)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.668 (0.422, 6.287)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.455 (0.034, 6.021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAbbreviations: OR, Odds ratio; aOR, Adjusted odds ratio; B, Regression coefficient; aB, Adjusted regression coefficient; PROM, premature rupture of membrane; PPH, postpartum hemorrhage; SGA, small for gestational age.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eConfounders adjusted for: gestational hyperglycemia, induction of labor, and use of ASA, immunosuppressants, and P4.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eIntrapartum interventions and labor duration in LMWH and control groups undergoing vaginal delivery\u003c/h3\u003e\n\u003cp\u003eA subgroup analysis was conducted among parturients who underwent vaginal delivery. Compared with the control subgroup, the LMWH subgroup demonstrated significantly higher rates of episiotomy and intrapartum oxytocin infusion (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no significant differences were observed between groups in the use of artificial rupture of membranes, phloroglucinol administration, epidural analgesia, forceps-assisted delivery, umbilical vein oxytocin injection, manual removal of the placenta, or the duration of labor stages (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAfter adjusting for gestational hyperglycemia, labor induction, and the use of ASA, immunosuppressants, and P4, multivariate regression analysis revealed that the LMWH subgroup had significantly increased odds of both forceps-assisted delivery (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;3.512; 95% confidence interval [CI]: 1.195\u0026ndash;10.325; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022) and episiotomy (aOR\u0026thinsp;=\u0026thinsp;3.059; 95% CI: 1.353\u0026ndash;6.914; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). No other significant differences were found in intrapartum interventions or labor durations after adjustment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntrapartum Interventions and Labor Duration in LMWH and Reference Groups Undergoing Vaginal Delivery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH subgroup\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-LMWH Subgroup\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;327)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR/ B (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaOR/ aB (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted \u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForceps-assisted delivery (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.616 (0.738, 3.536)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.512 (1.195, 10.325)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpisiotomy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.749 (1.019, 2.999)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.059 (1.353, 6.914)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhloroglucinol IV push (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.733 (0.416, 1.292)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.753 (0.294, 1.926)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural analgesia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142 (85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e284 (86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.896 (0.523, 1.535)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.850 (0.341, 2.118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin infusion (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115 (69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.383 (1.606, 3.535)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.015 (0.987, 4.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArtificial rupture of membranes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (10.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.819 (0.449, 1.493)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.276 (0.467, 3.487)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst stage (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.59 (5.31, 10.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.67 (5.00, 12.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.806 (-1.668, 0.057)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.320 (-1.773, 1.134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond stage (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.52, 1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83 (0.48, 1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.145 (-0.018, 0.309)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.245 (-0.030, 0.520)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird stage (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.09 (0.07, 0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08 (0.07, 0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.031 (-0.112, 0.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.017 (-0.153, 0.120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal labor duration (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.99 (6.23, 12.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.67 (6.00, 14.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.652 (-1.576, 0.272)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.086 (-1.993, 0.938)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUmbilical vein oxytocin injection (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.654 (0.321, 1.333)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.589 (0.180, 1.922)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.380\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual removal of placenta (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.434 (0.175, 1.077)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.508 (0.110, 2.336)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAbbreviations: OR: Odds ratio; aOR: Adjusted odds ratio; B: Regression coefficient; aB: Adjusted regression coefficient.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eConfounding factors adjusted for: gestational hyperglycemia, induction of labor, and use of ASA, immunosuppressants, and P4.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMaternal and neonatal outcomes in LMWH and control groups undergoing trial of vaginal delivery by onset of labor\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA subgroup analysis was conducted among parturients who underwent trial of vaginal delivery based on the onset of labor (induced vs. spontaneous). Among women who received LMWH during pregnancy, those who underwent labor induction had significantly greater gestational age at delivery and higher neonatal birth weight compared to those with spontaneous labor onset (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No other baseline characteristics differed significantly between these two LMWH subgroups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn the induced labor subgroup, the use of P4, ASA, and immunosuppressants was significantly more common among women who received LMWH than among those who did not (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while no significant differences were found in other clinical characteristics (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, among women with spontaneous labor onset, those who had received LMWH exhibited significantly higher rates of gestational hyperglycemia and more frequent use of P4, ASA, and immunosuppressants compared with those in the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences in other baseline characteristics were observed (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Clinical Characteristics of Parturients Undergoing Trial of Vaginal Delivery by Onset of Labor\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Induction Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLMWH Spontaneous Labor Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-LMWH Induction Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;133)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-LMWH Spontaneous Labor Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;241)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003ea\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003eb\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003ec\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.89\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m^2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2, 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0, 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational diabetes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational hypothyroidism (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication Use (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (72.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (66.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosup-pressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLabor Induction Methods (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCervical balloon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArtificial rupture of membranes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3239.67\u0026thinsp;\u0026plusmn;\u0026thinsp;382.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3107.53\u0026thinsp;\u0026plusmn;\u0026thinsp;337.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3188.98\u0026thinsp;\u0026plusmn;\u0026thinsp;452.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3182.20\u0026thinsp;\u0026plusmn;\u0026thinsp;484.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eAbbreviations: BMI, body mass index; ART, assisted reproductive technology; HDP, hypertensive disorders of pregnancy; ICP, intrahepatic cholestasis of pregnancy; P4, progesterone; ASA, acetylsalicylic acid.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eP\u003c/em\u003ea: Comparison between observation-induced and observation-spontaneous groups; \u003cem\u003eP\u003c/em\u003eb: Comparison between observation-induced and control-induced groups; \u003cem\u003eP\u003c/em\u003ec: Comparison between observation-spontaneous and control-spontaneous groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn women receiving LMWH during pregnancy, pregnancy outcomes did not differ significantly between induced and spontaneous labor after adjusting for delivery gestational age and birth weight (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Among women undergoing induced trial of vaginal delivery, maternal and neonatal outcomes did not differ significantly between the LMWH and control groups after adjusting for the use of P4, ASA, and immunosuppressants (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, among women with spontaneous labor onset, LMWH use was associated with a significantly increased risk of PPH overall and a significantly greater intrapartum blood loss in those who achieved vaginal delivery after adjustment for gestational hyperglycemia and the use of P4, ASA, and immunosuppressants (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No other significant differences in pregnancy outcomes were observed across the subgroups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMaternal and Neonatal Outcomes in LMWH and Reference groups Undergoing Trial of Vaginal Delivery by Onset of Labor\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Induction Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;92)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLMWH Spontaneous Labor Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-LMWH Induction Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;133)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-LMWH Spontaneous Labor Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;241)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ePa\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ePb\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ePc\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine atony (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abnormalities (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineal laceration (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency cesarean section (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrapartum blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e300 (300, 300)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300 (300, 350)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300 (300, 400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e300 (300, 400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108 (81.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e219 (89.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (100, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (100, 200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (100, 200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100 (100, 200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss 2 hours postpartum (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (50, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (50, 90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (50, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (50, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental adhesion (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta accreta (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeonatal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-minute Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-minute Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (10, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eAbbreviations: PROM, premature rupture of membrane; PPH, postpartum hemorrhage.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eP\u003c/em\u003ea: Comparison between LMWH induction and LMWH spontaneous labor groups, adjusted for gestational age and neonatal birth weight; \u003cem\u003eP\u003c/em\u003eb: Comparison between LMWH induction and control induction groups, adjusted for use of P4, ASA, and immunosuppressants; \u003cem\u003eP\u003c/em\u003ec: Comparison between LMWH spontaneous labor and control spontaneous labor groups, adjusted for gestational diabetes, and use of P4, ASA, and immunosuppressants.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIntrapartum interventions and labor duration in LMWH and control groups undergoing vaginal delivery by onset of labor\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn women receiving LMWH during pregnancy, those who underwent labor induction had significantly higher utilization rates of epidural analgesia and oxytocin augmentation compared to those with spontaneous labor onset, after adjusting for gestational age at delivery and neonatal birth weight (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notably, LMWH-exposed women undergoing induction demonstrated a increasing risk of episiotomy compared to non-exposed controls, independent of P4, aspirin, or immunosuppressant use (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No other significant differences in intervention rates or labor stage durations were observed between these groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn women with spontaneous labor onset, LMWH exposure was independently associated with a higher likelihood of instrumental delivery after controlling for gestational hyperglycemia and the use of P4, ASA, and immunosuppressants (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No other significant differences in intrapartum management or labor durations were noted between the LMWH and control groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntrapartum Interventions and Labor Duration in LMWH and Reference Groups Undergoing Vaginal Delivery by Onset of Labor\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLMWH Induction Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLMWH Spontaneous Labor Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-LMWH Induction Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;108)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-LMWH Spontaneous Labor Group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;219)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ePa\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ePb\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ePc\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForceps-assisted delivery (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpisiotomy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntravenous phloroglucinol (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEpidural analgesia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75 (91.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (79.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e102 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e182 (83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin infusion (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArtificial rupture of membranes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst stage (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.92 (5.40, 10.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.00 (5.25, 11.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.83 (4.71, 11.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.00 (5.33, 13.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond stage (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.97 (0.56, 1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94 (0.47, 1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.57, 1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80 (0.42, 1.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird stage (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.10 (0.07, 0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.08 (0.07, 0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09 (0.07, 0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.08 (0.07, 0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal labor duration (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.57 (6.23, 12.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.22 (6.10, 12.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.38 (5.93, 12.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.88 (6.17, 14.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUmbilical vein oxytocin injection (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual removal of placenta (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eP\u003c/em\u003ea: Comparison between LMWH induction and LMWH spontaneous labor groups, adjusted for gestational age and neonatal birth weight; \u003cem\u003eP\u003c/em\u003eb: Comparison between LMWH induction and control induction groups, adjusted for use of P4, ASA, and immunosuppressants; \u003cem\u003eP\u003c/em\u003ec: Comparison between LMWH spontaneous labor and control spontaneous labor groups, adjusted for gestational diabetes, and use of P4, ASA, and immunosuppressants.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMain findings\u003c/h2\u003e \u003cp\u003eThis study found that long-term LMWH use during pregnancy was associated with a reduced likelihood of cesarean delivery but an elevated risk of PPH compared to non-users. Among women who delivered vaginally, those receiving LMWH had a lower rate of intrapartum cesarean conversion but experienced greater blood loss and higher utilization of obstetric interventions such as instrumental delivery and episiotomy. Notably, in spontaneous labors, LMWH use was linked to an increased risk of hemorrhage, underscoring the need for careful monitoring during delivery. Importantly, no significant differences were observed in other maternal or neonatal outcomes, including placental complications or neonatal well-being. These findings suggest that while LMWH may support vaginal birth, it requires heightened vigilance for bleeding risks and individualized intrapartum care to optimize outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eThe major strength of this study lies in its focused investigation of pregnant women requiring LMWH - a population with high rates of labor induction. We systematically examined their labor characteristics, intrapartum interventions, and delivery outcomes through methodologically robust subgroup analyses stratified by mode of labor onset (induced versus spontaneous). This approach yielded clinically important insights into how LMWH exposure interacts with different labor patterns. Furthermore, our analysis accounted for key confounding variables, including concomitant medication use (such as ASA and P4), enhancing the reliability of our findings.\u003c/p\u003e \u003cp\u003eNevertheless, several limitations should be acknowledged. First, as a retrospective study, it is susceptible to potential biases, including incomplete documentation and variability in clinical practice over time, as well as the limited exposure detail regarding LMWH dosage, formulation, and last administration timing. Second, while we adjusted for key confounders, residual confounding from unmeasured factors such as patient preferences or nuanced clinical management cannot be excluded. In our cohort, LMWH regimens were frequently adjusted during pregnancy based on maternal weight, trimester-specific risk assessments, and evolving clinical conditions, resulting in substantial intra-individual dose variability. Therefore, although LMWH dosage is clinically relevant, we did not perform dosage stratification in our analysis, nor did we specifically address the outcomes associated with low-dose, intermediate-dose, or high-dose LMWH treatment at the time of delivery. Finally, the relatively limited sample size restricted our ability to incorporate all potentially relevant variables into the multivariable regression models. Future research should prioritize prospective, multicenter studies with standardized protocols to validate our findings. Additionally, mechanistic studies exploring the biological effects of LMWH on uterine contractility and cervical remodeling could provide deeper insights into its role in labor progression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation\u003c/h2\u003e \u003cp\u003eThe use of LMWH during pregnancy raises significant clinical concerns regarding its potential to increase the risk of PPH and influence the mode of delivery; however, the existing evidence on these outcomes remains conflicting. Galambosi et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] discovered no substantial difference in the incidence of PPH between the LMWH-treated group and the control group. In contrast, a systematic review and meta-analysis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reported that the utilization of LMWH during pregnancy notably elevated the risk of PPH. Nevertheless, it did not have a significant impact on the average blood loss or transfusion requirements when compared to the control group. This suggests that although LMWH may increase the likelihood of bleeding events, its partial anticoagulant effect does not significantly compromise overall hemostatic function. Our stratified analysis indicated that LMWH was linked to a higher risk of PPH and greater blood loss, particularly in spontaneous labors. This may be attributed to the combined impacts of physiological uterine contractions, trauma associated with vaginal delivery, and the anticoagulant characteristics of LMWH. Nevertheless, this association vanished in induced labors, potentially due to the fact that induction protocols alleviated the bleeding risk.\u003c/p\u003e \u003cp\u003eWhen examining delivery mode, Donnelly et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported higher induction rates without an increased CS rate with LMWH. Our study, however, found a reduced intrapartum CS rate during labor trials with LMWH, which is consistent with the findings of Ekman - Ordeberg et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], contributing to a lower overall CS rate. Nevertheless, it contrasts with the results of Andersen et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], who reported a higher CS rate attributed to maternal risk factors. This contrast raises the question of whether this reduction reflects differences in physician management rather than a pharmacological effect of LMWH. Specifically, in high - risk pregnancies requiring anticoagulation, clinicians may adopt a more conservative or expectant approach to labor, potentially avoiding interventions that could lead to a CS. However, after adjusting for maternal factors (age, BMI), complications (HDP, GDM), medications, and labor onset stratification, this association became non-significant in our study. This suggests that the observed difference is more likely attributable to underlying clinical characteristics and structured management of comorbidities rather than to LMWH itself. Therefore, while vigilant monitoring for hemorrhage remains essential, comprehensive management of maternal comorbidities appears to be the key factor in mitigating any apparent impact of LMWH on CS rates.\u003c/p\u003e \u003cp\u003ePlacental adhesion/accreta and abruption are major contributors to PPH and cesarean delivery, yet their associations with LMWH use differ significantly. Our study provides the first comprehensive clinical evidence that LMWH exposure is not significantly associated with retained placenta or histologically confirmed accreta after adjusting for confounders such as concomitant medications, maternal characteristics, and delivery methods. Mechanistically, LMWH promotes trophoblast proliferation, invasiveness, hCG secretion, and modulates angiogenesis and inflammation, theoretically affecting placental adhesion by altering trophoblast-endometrial interactions [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, our data do not support a causal link with placental adhesion disorders. This aligns with the pharmacological profile of LMWH, which appears insufficient to disrupt normal placental separation in vivo.\u003c/p\u003e \u003cp\u003eIn contrast, LMWH is associated with a reduced incidence of placental abruption in high-risk pregnancies. Studies by Gris et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Kupferminc et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] demonstrated that LMWH use was linked to a lower recurrence of abruption in women with thrombophilia or prior vascular complications, likely by preventing microthrombi formation and improving placental perfusion. Meta-analyses [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and our data confirm that LMWH does not increase abruption risk in general obstetric populations. These observations highlight that the association between LMWH and abruption may be context-dependent. It appears to have little effect on placental separation under normal conditions, but it may mitigate thrombotic processes that contribute to premature detachment in at-risk women. Consequently, LMWH neither exacerbates adhesion-related PPH nor abruption-related PPH, and may even lower emergency cesarean delivery rates in high-risk pregnancies by reducing abruption risk.\u003c/p\u003e \u003cp\u003eThe influence of LMWH on labor duration remains debated, with studies reporting conflicting results[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Our data showed no significant effect of LMWH on any labor stage after adjusting for maternal, obstetric, and pharmacological factors. Subgroup analyses by labor onset mode further supported this null association. Inconsistencies across studies may stem from population heterogeneity, LMWH regimen variations, or differences in labor management. Likewise, no significant associations were found between LMWH use and oxytocin, AROM, or phloroglucinol administration, indicating LMWH does not substantially affect labor progression or augmentation needs. Moreover, despite theoretical concerns about epidural hematoma, LMWH exposure did not reduce epidural rates significantly\u0026mdash;likely due to strict protocol adherence, including timely discontinuation before delivery. Labor induction may facilitate better timing of LMWH cessation compared to spontaneous labor [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Overall, with standard guidelines, LMWH does not clearly influence key intrapartum interventions.\u003c/p\u003e \u003cp\u003eOur study provides novel insights into the potential impact of antenatal LMWH on intrapartum interventions, particularly forceps-assisted delivery and episiotomy. Prior research reported no significant difference in forceps delivery rates among women with pre-pregnancy dalteparin exposure[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In contrast, our findings demonstrate that current antenatal LMWH administration is associated with elevated risks of both interventions. The observed association may arise from the interplay of pharmacological and pathophysiological factors. LMWH's anticoagulant properties could influence perineal tissue integrity, increasing the likelihood of episiotomy[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A more direct explanation may be found in clinical decision-making. Caregivers, perceiving LMWH prophylaxis (either due to the medication itself or the underlying maternal condition such as thrombophilia or placental insufficiency) as a risk factor, may opt for a more expedient delivery. This approach could involve a higher likelihood of performing an episiotomy to expedite the second stage of labor or a greater propensity for instrumental delivery to avoid prolonged labor and potential fetal compromise in at-risk pregnancies[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Notably, subgroup analyses showed that LMWH-exposed women undergoing labor induction required episiotomies more frequently, while those experiencing spontaneous labor onset had higher rates of forceps-assisted deliveries. These findings underscore that the mode of labor initiation may modulate LMWH's influence on delivery outcomes.\u003c/p\u003e \u003cp\u003eMultiple studies, including ours, have demonstrated that LMWH does not adversely affect key neonatal outcomes, such as SGA, macrosomia, oligohydramnios, or PROM [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Some studies have suggested that LMWH treatment may increase fetal birth weight, particularly in high-risk populations such as pregnancies with fetal growth restriction[\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. However, this effect does not appear to increase the risk of macrosomia after adjusting for maternal age, BMI, and gestational age at delivery[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Importantly, LMWH does not cross the placenta, supporting its established fetal safety profile. Overall, the accumulated evidence strongly supports the neonatal safety profile of LMWH.\u003c/p\u003e \u003cp\u003eIn conclusion, our study demonstrates that while long-term LMWH use during pregnancy is associated with reduced cesarean delivery rates, it requires careful monitoring due to increased PPH risk, particularly in spontaneous labors. Importantly, LMWH shows no adverse effects on placental adhesion disorders or key neonatal outcomes. Importantly, the observed increases in obstetric interventions (forceps delivery and episiotomy) appear mediated by a combination of pharmacological properties and underlying maternal risk factors rather than direct LMWH effects. Collectively, our findings support LMWH's overall safety in pregnancy when managed appropriately, while highlighting critical areas for optimized clinical practice and future research to further refine risk-benefit assessments in this population.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAPS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eAntiphospholipid Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eAssisted Reproductive Technology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eAcetylsalicylic Acid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eBody Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eHypertensive Disorders of Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eICP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eIntrahepatic Cholestasis of Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLMWH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eLow molecular weight heparin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003ePropensity Score Matching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePPH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eProgesterone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eRSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eRecurrent Spontaneous Abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSGA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eSmall for Gestational Age\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eVTE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eVenous Thromboembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained by the Institutional Review Board of the the Second Affiliated Hospital of Wenzhou Medical University (Approval No. 2024-K-111-01), and conducted in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;Given the retrospective nature of the study and the use of anonymized clinical data, the requirement for informed consent was waived by the Institutional Review Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis work was supported by Zhejiang province medical science and technology of China (grant number 2025KY1010) and Wenzhou Municipal Science and Technology Bureau (grant number GY20250286).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eKechen Li and Li Zhou\u0026nbsp;contributed to the design of the work and collected the data. Jieni Zou revised the manuscript and organized the data. Yujia Zhou drafted the article. Zhaoxia Huang collected the data. Ke Dong and Ying Hua supervised the analyses and revised the manuscript. All authors have contributed to the design of the study, drafting the paper and revising it critically for important intellectual content and approved it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors would like to thank all women who gave up their time to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaad A, Safarzadeh M, Shepherd M. Anticoagulation Regimens in Pregnancy. Obstetrics and Gynecology Clinics of North America. 2023;50:241\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ogc.2022.10.010\u003c/span\u003e\u003cspan address=\"10.1016/j.ogc.2022.10.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbattista M, Capecchi M, Gianniello F, Artoni A, Bucciarelli P, Ciavarella A, et al. A retrospective study on the use of low-molecular-weight heparin for prevention of pregnancy-related recurrent venous thromboembolism and obstetrical complications. Blood Coagul Fibrinolysis. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MBC.0000000000001190\u003c/span\u003e\u003cspan address=\"10.1097/MBC.0000000000001190\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Ippolito S, Ortiz AS, Veglia M, Tersigni C, Di Simone N. Low Molecular Weight Heparin in Obstetric Care: A Review of the Literature. Reprod Sci. 2011;18:602\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1933719111404612\u003c/span\u003e\u003cspan address=\"10.1177/1933719111404612\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalambosi PJ, Kaaja RJ, Stefanovic V, Ulander V-M. Safety of low-molecular-weight heparin during pregnancy: a retrospective controlled cohort study. Eur J Obstet Gynecol Reproductive Biology. 2012;163:154\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejogrb.2012.05.010\u003c/span\u003e\u003cspan address=\"10.1016/j.ejogrb.2012.05.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkman-Ordeberg G, Hellgren M, \u0026Aring;kerud A, Andersson E, Dubicke A, Sennstr\u0026ouml;m M, et al. Low molecular weight heparin stimulates myometrial contractility and cervical remodeling in vitro. Acta Obstet Gynecol Scand. 2009;88:984\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00016340903176818\u003c/span\u003e\u003cspan address=\"10.1080/00016340903176818\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkman-Ordeberg G, \u0026Aring;kerud A, Dubicke A, Malmstr\u0026ouml;m A, Hellgren M. Does low molecular weight heparin shorten term labor? Acta Obstet Gynecol Scand. 2010;89:147\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/00016340903294272\u003c/span\u003e\u003cspan address=\"10.3109/00016340903294272\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandstr\u0026ouml;m A, Cnattingius S, Wikstr\u0026ouml;m A-K, Stephansson O, Iliadou AN. Does Use of Low-Molecular-Weight Heparin during Pregnancy Influence the Risk of Prolonged Labor: A Population-Based Cohort Study. PLoS ONE. 2015;10:e0140422. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0140422\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0140422\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnol HM, Schultinge L, Veeger NJGM, Kluin-Nelemans HC, Erwich JJHM, Meijer K. The risk of postpartum hemorrhage in women using high dose of low-molecular-weight heparins during pregnancy. Thromb Res. 2012;130:334\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.thromres.2012.03.007\u003c/span\u003e\u003cspan address=\"10.1016/j.thromres.2012.03.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSirico A, Saccone G, Maruotti GM, Grandone E, Sarno L, Berghella V, et al. Low molecular weight heparin use during pregnancy and risk of postpartum hemorrhage: a systematic review and meta-analysis. J Maternal-Fetal Neonatal Med. 2019;32:1893\u0026ndash;900. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14767058.2017.1419179\u003c/span\u003e\u003cspan address=\"10.1080/14767058.2017.1419179\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonnelly J, Byrne J, Murphy K, McAuliffe F. Obstetric outcome with low molecular weight heparin therapy during pregnancy. Ir Med J. 2012;105:27\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLester W, Walker N, Bhatia K, Ciantar E, Banerjee A, Trinder J, et al. British Society for Haematology guideline for anticoagulant management of pregnant individuals with mechanical heart valves. Br J Haematol. 2023;202:465\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/bjh.18781\u003c/span\u003e\u003cspan address=\"10.1111/bjh.18781\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstetrics \u0026amp; Gynecology. 2019;133:e164\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/AOG.0000000000003074\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000003074\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Obstetricians and Gynecologists\u0026rsquo; Committee on Practice Bulletins\u0026mdash;Obstetrics. ACOG Practice Bulletin 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018;132:e1\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/AOG.0000000000002706\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000002706\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEscobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, et al. FIGO recommendations on the management of postpartum hemorrhage 2022. Intl J Gynecol Obste. 2022;157:3\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ijgo.14116\u003c/span\u003e\u003cspan address=\"10.1002/ijgo.14116\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFavilli A, Tosto V, Ceccobelli M, Parazzini F, Franchi M, Bini V, et al. Risk factors for non-adherent retained placenta after vaginal delivery: a systematic review. BMC Pregnancy Childbirth. 2021;21:268. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12884-021-03721-9\u003c/span\u003e\u003cspan address=\"10.1186/s12884-021-03721-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonovan BM, Shainker SA, Placenta Accreta Spectrum. NeoReviews. 2021;22:e722\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/neo.22-11-e722\u003c/span\u003e\u003cspan address=\"10.1542/neo.22-11-e722\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZilberman Sharon N, Pekar-Zlotin M, Kugler N, Accart Z, Nimrodi M, Melcer Y, et al. Oligohydramnios: how severe is severe? J Maternal-Fetal Neonatal Med. 2022;35:5754\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14767058.2021.1892068\u003c/span\u003e\u003cspan address=\"10.1080/14767058.2021.1892068\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrelabor Rupture of Membranes. ACOG Practice Bulletin, Number 217. Obstet Gynecol. 2020;135:e80\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/AOG.0000000000003700\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000003700\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguefack Tchente C, Njamen Nana T, Nkemtendong Tolefac P, Hongieh Abanda M, Endomba Angong FT, Tamambang RF, et al. Effects of phloroglucinol on the active phase of labour (EPAL trial): a single blinded randomised controlled trial in a tertiary hospital in sub-Sahara Africa. Pan Afr Med J. 2018;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.11604/pamj.2018.30.17.14728\u003c/span\u003e\u003cspan address=\"10.11604/pamj.2018.30.17.14728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFirst and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstet Gynecol. 2024;143:144\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/AOG.0000000000005447\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000005447\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersen AS, Berthelsen JG, Bergholt T. Venous thromboembolism in pregnancy: prophylaxis and treatment with low molecular weight heparin. Acta Obstet Gynecol Scand. 2010;89:15\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/00016340903370098\u003c/span\u003e\u003cspan address=\"10.3109/00016340903370098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOberkersch R, Attorresi AI, Calabrese GC. Low-molecular-weight heparin inhibition in classical complement activaton pathway during pregnancy. Thromb Res. 2010;125:e240\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.thromres.2009.11.030\u003c/span\u003e\u003cspan address=\"10.1016/j.thromres.2009.11.030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobel ML, Kingdom J, Drewlo S. Angiogenic Response of Placental Villi to Heparin. Obstet Gynecol. 2011;117:1375\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/AOG.0b013e31821b5384\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0b013e31821b5384\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y, Wu X-X, Tan J, Liu M, Liu Y, Zhang J-P. Effects of low molecular weight heparin and heparin-binding epidermal growth factor on human trophoblast in first trimester. Fertil Steril. 2012;97:764\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.fertnstert.2011.12.002\u003c/span\u003e\u003cspan address=\"10.1016/j.fertnstert.2011.12.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGris J-C, Chauleur C, Faillie J-L, Baer G, Mar\u0026egrave;s P, Fabbro-Peray P, et al. Enoxaparin for the secondary prevention of placental vascular complications in women with abruptio placentae: The pilot randomised controlled NOH-AP trial. Thromb Haemost. 2010;104:771\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1160/TH10-03-0167\u003c/span\u003e\u003cspan address=\"10.1160/TH10-03-0167\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKupferminc M, Rimon E, Many A, Maslovitz S, Lessing JB, Gamzu R. Low molecular weight heparin versus no treatment in women with previous severe pregnancy complications and placental findings without thrombophilia. Blood Coagul Fibrinolysis. 2011;22:123\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MBC.0b013e328343315c\u003c/span\u003e\u003cspan address=\"10.1097/MBC.0b013e328343315c\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodger M, De Vries JI, Rey E, Gris J-CJ, Martinelli I, Schleussner E, et al. Low Molecular Weight Heparin for Prevention of Placenta-Mediated Pregnancy Complications: An Individual Patient Data Meta-Analysis. Blood. 2015;126:890\u0026ndash;890. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1182/blood.V126.23.890.890\u003c/span\u003e\u003cspan address=\"10.1182/blood.V126.23.890.890\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRottenstreich A, Zacks N, Kleinstern G, Levin G, Sompolinsky Y, Mankuta D, et al. Planned induction versus spontaneous delivery among women using prophylactic anticoagulation therapy: a retrospective study. BJOG. 2020;127:1241\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/1471-0528.16247\u003c/span\u003e\u003cspan address=\"10.1111/1471-0528.16247\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoueli A, Cesario E, Amsellem J, Agman A, Vauthier-Brouzes D, Nizard J. Is a therapeutic anticoagulation window needed for delivery when using prophylactic low molecular weight heparin during pregnancy? A retrospective monocentric study. Eur J Obstet Gynecol Reproductive Biology. 2017;215:118\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejogrb.2017.05.019\u003c/span\u003e\u003cspan address=\"10.1016/j.ejogrb.2017.05.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaine K, Yli BM, Cole V, Schwarz C, Kwee A, Ayres-de-Campos D, et al. European guidelines on perinatal care- Peripartum care Episiotomy. J Maternal-Fetal Neonatal Med. 2022;35:8797\u0026ndash;802. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14767058.2021.2005022\u003c/span\u003e\u003cspan address=\"10.1080/14767058.2021.2005022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerma GL, Spalding JJ, Wilkinson MD, Hofmeyr GJ, Vannevel V, O\u0026rsquo;Mahony F. Instruments for assisted vaginal birth. Cochrane Database Syst Reviews. 2021;2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD005455.pub3\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD005455.pub3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeruelle P, Denervaud M, Hachulla E, Ducloy-Bouthors A-S, Valat A-S, Puech F, et al. Use of low-molecular-weight heparin from the first trimester of pregnancy: A retrospective study of 111 consecutive pregnancies. Eur J Obstet Gynecol Reproductive Biology. 2006;127:73\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejogrb.2005.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.ejogrb.2005.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu J, Tang Y, Peng B, Zhang W, Wang X. Effect of low-molecular‐weight heparin on placenta‐mediated fetal growth restriction in a tertiary referral hospital: A 7‐year retrospective cohort study. Intl J Gynecol Obste. 2024;165:220\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ijgo.15098\u003c/span\u003e\u003cspan address=\"10.1002/ijgo.15098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eComparison of Low Molecular Weight Heparin. Used alone or Combined with Aspirin in the Treatment of Fetal Growth Restriction. J Coll Physicians Surg Pak. 2022;32:1228\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.29271/jcpsp.2022.09.1228\u003c/span\u003e\u003cspan address=\"10.29271/jcpsp.2022.09.1228\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBettiol A, Avagliano L, Lombardi N, Crescioli G, Emmi G, Urban ML, et al. Pharmacological Interventions for the Prevention of Fetal Growth Restriction: A Systematic Review and Network Meta-Analysis. Clin Pharma Ther. 2021;110:189\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/cpt.2164\u003c/span\u003e\u003cspan address=\"10.1002/cpt.2164\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLowry DE, Corsi DJ, White RR, Guo M, Lanes A, Smith G, et al. Association between prophylactic low-molecular‐weight heparin use in pregnancy and macrosomia: analysis of the Ottawa and Kingston birth cohort. J Thromb Haemost. 2019;17:345\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jth.14358\u003c/span\u003e\u003cspan address=\"10.1111/jth.14358\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"molecular-weight heparin, labor, induced, pregnancy outcome, postpartum hemorrhage, anticoagulants, cesarean section","lastPublishedDoi":"10.21203/rs.3.rs-8700142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8700142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To evaluate the effects of long-term low molecular weight heparin (LMWH) use during pregnancy on labor process and pregnancy outcomes under different labor onset methods, aiming to inform clinical application strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis retrospective cohort study included parturients from November 2020 to November 2024. Subjects were grouped based on LMWH exposure and matched using propensity score matching (PSM, 1:2 ratio) for six baseline variables. Subgroup analyses were conducted by labor onset mode (induced vs. spontaneous). Clinical data, pregnancy complications, medications, delivery interventions, and pregnancy outcomes were compared. Multivariate regression analyses were used to assess LMWH’s effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e LMWH use was associated with increased postpartum hemorrhage (PPH) risk (aOR = 2.497, \u003cem\u003eP\u003c/em\u003e= 0.032) but reduced CS rates (aOR = 0.617, \u003cem\u003eP\u003c/em\u003e = 0.027). In vaginal deliveries, LMWH users showed higher risks of forceps-assisted delivery (aOR = 3.512, \u003cem\u003eP\u003c/em\u003e = 0.022) and episiotomy (aOR = 3.059, \u003cem\u003eP\u003c/em\u003e = 0.007). In spontaneous labor, LMWH was linked to greater intrapartum blood loss and PPH risk. No significant impact was found on labor duration or neonatal outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Long-term antenatal LMWH use increases PPH and operative vaginal delivery risk, particularly under spontaneous labor. Findings support individualized labor management in LMWH-treated pregnancies.\u003c/p\u003e","manuscriptTitle":"Labor characteristics and Perinatal Outcomes Associated with Low Molecular Weight Heparin Therapy: Differential Effects in Induced versus Spontaneous Labor","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 05:42:08","doi":"10.21203/rs.3.rs-8700142/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T07:48:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T16:18:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107451301938563535547493936911270615552","date":"2026-02-15T16:12:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T13:41:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T12:49:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T12:07:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324707663153245388450174917068886234669","date":"2026-02-15T06:44:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249644426910059027792153405639106758238","date":"2026-02-14T08:31:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209879955069963749491521120374667812809","date":"2026-02-13T10:15:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159453094304281748907209384866419777425","date":"2026-02-12T20:05:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294709910599885612748641099491949132560","date":"2026-02-12T16:25:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T08:49:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4669319825694866585478163277592000511","date":"2026-02-12T08:43:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79973964431901512616119034527228120019","date":"2026-02-12T07:24:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"147760404336722437416357184861198654328","date":"2026-02-12T07:22:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T07:17:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-02T11:56:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-02T11:44:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-01T15:26:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-02-01T11:53:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"514bfc41-8112-44e6-ba0d-d57b6824028b","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T12:23:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 05:42:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8700142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8700142","identity":"rs-8700142","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}