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Background Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. Methods An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set. Results The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined. Conclusions We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.

The traditional Lamaze breathing technique has limitations. We analyzed the effect of our new warm and calm (WC) breathing pattern on the incidence of fetal intrauterine distress, emergency cesarean delivery, forceps-assisted delivery, episiotomy, third- and fourth-degree perineal tears, and postpartum hemorrhage. Pregnant women who underwent a labor trial at the Second Hospital of West China University of Sichuan University between January 2020 and November 2023 and practiced the WC breathing pattern ( n  = 28,369) were recruited as the study group and those who underwent routine labor and practiced the Lamaze breathing technique between January 2016 and December 2019 ( n  = 21,110) constituted the control group. The chi-square test was used to compare differences in the incidence of fetal intrauterine distress, emergency cesarean delivery, forceps-assisted delivery, episiotomy, third- and fourth-degree perineal tears, and postpartum hemorrhage between the two groups. The incidence of the aforementioned events was significantly lower in the study group than in the control group. P-values were all ˂0.05, indicating significant differences. The WC breathing pattern increases the chances of a labor trial for pregnant women; reduces the incidence of fetal intrauterine distress, emergency cesarean delivery, forceps-assisted delivery, episiotomy, third- and fourth-degree perineal tears, and postpartum hemorrhage; and promotes safe delivery.

Background Premature rupture of membranes (PROM) at ≥ 36 weeks elevates intrauterine infection risks, making timely labor induction the preferred intervention. While oxytocin infusion remains the conventional approach, its efficacy proves suboptimal in cases with unfavorable cervical conditions. Oral low-dose misoprostol emerges as a promising solution. Aim The primary objective of this study was to compare the general obstetric delivery information and outcomes following the administration of oxytocin infusion or oral low-dose misoprostol solution for labor induction in PROM at ≥ 36 weeks women with an unfavorable cervical condition. Methods A retrospective cohort study was conducted at a tertiary general hospital in China from March 2020 to November 2024, comparing oxytocin infusion and oral administration of 25 µg misoprostol every 2 h for labor induction in PROM at ≥ 36 weeks women with a Bishop score < 6. A total of 622 mothers were enrolled, with 297 in the oxytocin group and 325 in the misoprostol group. Results The rates of vaginal delivery and failed induction of labor were comparable between the two groups. Moreover, the duration of first stage of labor time was shorter in the misoprostol group relative to that of the oxytocin group (9.2 ± 4.8 h vs. 10.3 ± 5.0 h, p  = 0.03), as well as the duration of administration to vaginal delivery (22.0 ± 10.8 h vs. 24.4 ± 12.1 h, p  = 0.03). The rate of vaginal delivery in 24 h was high following induction with oral misoprostol [61.2% (137/224) vs. 51.2% (103/201), p  = 0.04]. Notably, the incidence of uterine hyperstimulation, fetal distress, or suspected intrauterine infection was not significantly different between the two groups; however, there was a markedly lower incidence of overall postpartum hemorrhage (PPH) [8.6% (28/325) vs. 17.8% (53/297), p  < 0.001] and severe PPH following vaginal delivery [0.4% (1/224) vs. 3.5% (7/201), p  = 0.02] observed in the misoprostol group. Logistic regression analysis revealed that misoprostol administration was negatively associated with the occurrence of PPH (aOR: 0.42; 95% CI: 0.23 ~ 0.76, p  < 0.01). Conclusions In this retrospective single-center study, oral low-dose misoprostol yielded similar effects as oxytocin infusion on labor induction in PROM at ≥ 36 weeks pregnancies with unfavorable cervix, with a potentially lower risk of PPH. Nevertheless, these findings need to be further investigated through prospective multicenter studies.

Background Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. Methods We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. Results Out of 417 participants, most were aged 35–37 years ( n  = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% ( n  = 157, 95%CI: 33.1–42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44–2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48–3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34–3.9). Conclusion Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.

Background Pregnancy and delivery outcomes in women with Fabry disease are not well described. Methods Retrospective cohort-study of women with Fabry disease in Austria using a specific questionnaire and the Austrian Mother–Child Health Passport. Results Out of a total of 44 enrolled women (median age at study entry 44 years, p25: 30, p75: 51), 86.4% showed signs and symptoms of Fabry disease with an increase in pain burden during pregnancy, primarily in women with moderate pain before pregnancy. Thirty-two of 44 women with Fabry disease reported a total of 70 pregnancies (median age at first pregnancy 24 years, p25: 21, p75: 31), 61 (87.1%) of which resulted in 64 live births including 3 sets of twins, six miscarriages (8.6%) in five women, and three induced abortions (4.3%) in two women. Risk factors for poor maternal and foetal outcomes during pregnancy, overrepresented in our cohort as compared to the general population, were hypertension ( n  = 10, 16.4%), proteinuria ( n  = 17, 27.9%) and smoking ( n  = 24, 39.3%). Preeclampsia was reported in 7 pregnancies (11.5%). Fifty-one (79.7%) children were born at term and 13 (20.3%) were preterm (including one neonatal death), with a median gestational age of 39 weeks (p25: 38, p75: 40) and delivery by C-section in 15 pregnancies (24.6%). Thirteen (20.3%) children presented with low birth weight and 18 (28.1%) were small for their gestational age. In comparison to global and national data-sets, preeclampsia, prematurity, low birth weight, being small for their gestational age as well as inpatient stay were significantly more common in patients with Fabry disease. Conclusions Our cohort-study in women with Fabry disease shows an increase of pain burden during pregnancies and clearly points to an increased risk for preeclampsia, prematurity, and neonates small for gestational age. With a substantial number of high-risk pregnancies, neonatal outcomes are somewhat worse in Fabry disease than in the general public. Thus, we provide valuable data enabling informed decision-making in pregnancy counselling for Fabry disease.

A majority (>80%) of maternal deaths in the United States are preventable. Using machine learning (ML) models that are generated from electronic medical records (EMRs) may be a promising approach to predict the risk of adverse maternal outcomes and enable proactive intervention to prevent maternal mortality. Current evidence syntheses of such ML approaches either focus only on specific maternal outcomes, aspects other than risk prediction, or do not consider the full pipeline of studies from the development to implementation in clinical practice. The goal of this scoping review is to document evidence for the use of ML models for predicting the risk of maternal morbidity and mortality outcomes (research objective [RO1]), the translation of such models into applications for clinical use by providers (RO2), and factors associated with the implementation of clinical applications in practice (RO3). The review was limited to studies in health care settings, using data from EMRs. A detailed search string was developed in collaboration with a health sciences librarian and implemented on February 20, 2023, on PubMed, CINAHL Plus, Scopus, Embase, and IEEE Xplore. Two reviewers independently reviewed titles and abstracts for inclusion, and a third reviewer resolved conflicts. Only full-length journal articles published in English were included. Studies using non-EMR data exclusively were excluded. Two reviewers independently reviewed full texts for inclusion, and a third reviewer resolved conflicts. A structured template was used for data extraction, and findings were summarized descriptively. From 480 deduplicated studies identified from the search, 142 studies were included for full-text review, and 39 studies were included in the review. More than half of the included studies were conducted in 2022, and 34 studies were from just 3 countries (United States, China, and Israel). More studies focused on identifying the risk of pregnancy and delivery outcomes compared with postpartum outcomes. The top 3 most common outcomes for risk prediction were cardiovascular risks and hypertensive disorders of pregnancy (9 studies), gestational diabetes (7 studies), and postpartum hemorrhage (6 studies). Data were labeled with computable phenotypes in 30 studies, and the most often used method in ML models was boosting methods (18 studies). The most common metric used to assess model performance was area under the precision-recall curve (AUPRC; 33 studies). No studies described clinical applications of ML models for providers (RO2) or associated implementation factors (RO3). Key recommendations for future research and practice include expanding efforts to study maternal morbidity and mortality outcomes in the postpartum period, increasing transparency and reproducibility of studies through use of reporting checklists, and expanding efforts to implement ML models in clinical practice.

Purpose Maternal obesity is associated with newborn morbidity and mortality; however, the literature discussing bariatric surgical effects on women’s fertility and pregnancy has reached diverse conclusions. We examined the effect of laparoscopic sleeve gastrectomy (LSG) on pregnancy, birth, and newborn outcomes regarding the time of conception. Materials and Methods We conducted a retrospective review of women who had LSG and conceived between 2007 and 2017. Data included maternal parameters, pregnancy progression, delivery, and newborn status. Pregnancies were divided into subgroups according to surgery to conception interval (≤ 12, 12–24, ≥ 24 months). Results We reviewed 68 patients: 48 (70%) conceived once, 13 (19%) conceived twice, 7 women (10%) conceived three times. There were 95 pregnancies and 80 live births. The group sizes were 18 (18.9%), 29 (30.5%), and 48 (50.5%) pregnancies for ≤ 12, 12–24, and 24 months after surgery, respectively. No difference was found between the subgroups regarding basic characteristics at time of surgery (age ( p  = 0.100), weight ( p  = 0.180), BMI ( p  = 0.616); and at beginning of pregnancy weight ( p  = 0.309), BMI ( p  = 0.707), %EBMIL ( p  = 0.321)). No significant differences were found concerning pregnancy progression, complications, and the newborns’ weight ( p  = 0.41), GCT ( p  > 0.99), preeclampsia ( p  = 0.492), eclampsia ( p  > 0.99), Pre-term ( p  = 0.428), live birth ( p  = 0.432), LGA ( p  > 0.99), SGA ( p  = 0.732). A statistically significant trend of increased rates of caesarean section in subject with longer surgery-to-conception intervals was detected ( P  = 0.022). Conclusions Our results did not show that the interval between LSG and conception affects the pregnancy and newborn outcomes. Therefore, we believe that early conception following LSG does not increase the risk of maternal or neonatal morbidity or mortality. Graphical abstract

Background Performing exercise with medium intensity has positive effects on the maternal health. The aim of this study was to investigate the effectiveness of Pilates exercise program during pregnancy on childbirth outcomes: Methods This clinical trial study was performed on 110 primiparous women who were randomly divided into two groups of intervention ( n  = 55) and control ( n  = 55). The intervention group performed Pilates exercises from 26 to 28 weeks of gestation for 8 weeks while the control group did not do any exercise. Data collection tools included Visual Analog Scale (VAS), Mackey Childbirth Satisfaction Rating Scale, and a checklist including demographic and obstetrics information. Results The results of the study showed that Pilates exercise during pregnancy significantly reduces the labor pain intensity, length of the active phase and second stage of labor and increases maternal satisfaction of the labor process ( p  < 0.05). Based on the Kaplan Meyer analysis, the mean whole length of labor was shorter in Pilates exercise group than in the control group ( P  = .004). There was no statistically significant difference between the two groups in terms of Episiotomy, type of delivery, first and fifth Apgar score of neonates ( p  > 0.05). Conclusion According to the results of this study, Pilates exercise during pregnancy improved the labor process and increased maternal satisfaction of chidbirthprocess, without causing complications for the mother and baby. However, studies with larger sample sizes are recommended to prove the efficacy and safty of this practiceduring labor. Trial registration IRCT registration number: IRCT20200126046266N1 . Registration date: 2020-05-02 (retrospectively registered).

This was a hospital registry-based retrospective age-matched cohort study that aimed to compare pregnancy and neonatal outcomes of women with pre-existing mental disorders with those of mentally healthy women. A matched cohort retrospective study was carried out in the Department of Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, a tertiary health care institution. Medical records of pregnant women who gave birth from 2006 to 2015 were used. The study group was comprised of 131 pregnant women with mental disorders matched to 228 mentally healthy controls. The primary outcomes assessed were antenatal care characteristics; secondary outcomes were neonatal complications. Pregnant women with pre-existing mental health disorders were significantly more likely to have low education, be unmarried and unemployed, have a disability that led to lower working capacity, smoke more frequently, have chronic concomitant diseases, attend fewer antenatal visits, gain less weight, be hospitalized during pregnancy, spend more time in hospital during the postpartum period, and were less likely to breastfeed their newborns. The newborns of women with pre-existing mental disorders were small for gestational age (SGA) more often than those of healthy controls (12.9% vs. 7.6%, p < 0.05). No difference was found comparing the methods of delivery. Women with pre-existing mental health disorders had a worse course of pregnancy. Mental illness increased the risk to deliver a SGA newborn (RR 2.055, 95% CI 1.081-3.908).

PurposeTo (i): examine whether maternal dietary inflammation assessed using the dietary inflammatory index (DII) is associated with gestational weight gain (GWG) and delivery outcomes in urban South African women from the Soweto First 1000-Day Study (S1000); and (ii): explore whether serum high-sensitivity c-reactive protein (hs-CRP) levels mediate these associations.MethodsEnergy-adjusted-DII (E-DII™) scores were calculated for 478 pregnant women using a quantitative food frequency questionnaire. GWG (kg/week) was assessed via anthropometry and hs-CRP concentrations were assessed in a sub-sample at < 14 (n = 263) and at 24–28 (n = 270) weeks gestational age. Multivariable linear and logistic regression models were used to examine associations between maternal E-DII scores, GWG, hs-CRP concentrations, and delivery outcomes.ResultsPositive vs. negative E-DII scores were associated with an increased odds of excessive weight gain (OR (95% CI): 2.23 (1.20; 4.14); P = 0.01) during pregnancy. Higher hs-CRP concentrations in the first trimester were associated with lower weight-for-length z-score (β (95% CI): −0.06 (−0.11; −0.01) per 1 mg/l hs-CRP; P = 0.02) and a reduction in odds of a large-for-gestational age delivery (OR (95% CI): 0.66 (0.47; 0.94); P = 0.02). Higher hs-CRP concentrations in the second trimester were associated with an increased odds of delivering preterm (OR (95% CI): 1.16 (1.01; 1.32); P = 0.03).ConclusionsConsumption of an anti-inflammatory diet during pregnancy reduced the risk of excessive GWG in a rapidly urbanising setting (Soweto, South Africa), where obesity prevalence rates are high. Further research is needed to better understand how maternal diet may ameliorate the effects of maternal adiposity on inflammatory milieu and fetal programming.