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Venous thromboembolism (VTE) is a severe complication associated with cesarean delivery (c.d.). The risk of VTE has been estimated to be 2–4-fold higher compared to vaginal delivery and appears independent of other risk factors. Pharmacologic thromboprophylaxis after c.d. represents a daily challenge for obstetricians and is a common practice in many countries such as in Germany. However, the evidence of thromboprophylaxis efficacy is based on only four randomized controlled trials and one prospective cohort study. Risk assessment models to predict VTE after c.d. have not adequately been validated. According to meta-analyses pharmacologic thromboprophylaxis was not associated with a significant reduction in the risk of VTE but is associated with an increased risk of bleeding and hematomas compared to placebo. Due to the lack of evidence current guidelines differ markedly regarding recommendations on post-cesarean pharmacologic thromboprophylaxis. Most guidelines recommend no pharmacologic thromboprophylaxis after elective c.d. in the absence of additional VTE risk factors. In case of additional risk factors associated with elective c.d. as well as in case of emergency c.d. pharmacologic prophylaxis is advised for 7–10 days after delivery, and for at least 6 weeks after c.d. in high-risk patients. In view of the great number of various risk factors, the challenge not recognizing all risk factors timely and the low incidence of serious complications associated with the use of low molecular weight heparin (LMWH), we consent with others to suggest universal LMWH prophylaxis following c.d. rather than a selective being aware that universal LMWH prophylaxis is associated with significantly higher costs.

Introduction Congenital heart defects (CHDs) are a leading cause of neonatal morbidity and mortality globally. Accurate prenatal detection is crucial to improving neonatal outcomes. In Indonesia, two primary methods are used: fetal cardiac screening (FCS), which is accessible but limited in sensitivity (40–60 %), and fetal echocardiography (FE), the gold standard with over 90 % sensitivity but limited access due to infrastructural and financial challenges. Content This review analyzes Indonesia’s diagnostic disparities, highlighting how rural regions rely heavily on FCS, while FE remains restricted to urban centers. Emerging technologies, such as AI-enhanced diagnostics and telemedicine, show promise in bridging gaps by increasing FCS accuracy and extending access to FE through remote consultations. Summary AI has the potential to boost FCS sensitivity by up to 30 %, making it an effective preliminary screening tool, while telemedicine platforms connect rural practitioners to urban specialists. However, barriers like insufficient infrastructure, regulatory issues, and limited training hinder widespread adoption. Outlook Addressing these gaps requires standardized national protocols, capacity-building initiatives, and public-private partnerships to finance infrastructure and reduce costs. With technology integration and systemic reforms, Indonesia can achieve equitable CHD diagnostics, improving maternal and neonatal outcomes and aligning with global standards.

Objectives To compare the antidiuretic effects of oxytocin and carbetocin in patients undergoing elective caesarean section. Methods This retrospective cohort study included 276 participants who underwent elective singleton caesarean sections, with 184 receiving oxytocin and 92 receiving carbetocin. Exclusion criteria comprised patients with additional medical conditions or drug use affecting urine output, those diagnosed with postpartum hemorrhage, and those requiring non-standard intravenous fluid administration or additional uterotonics. Data on demographic characteristics, urinary output, time to reach specific urine output thresholds (500 mL, 1,000 mL, and 1,500 mL), vital signs, and hemoglobin levels were collected and compared between the oxytocin and carbetocin groups. Results There were no significant differences in demographic characteristics between the groups. There were no significant differences in preoperative and postoperative hemoglobin levels, vital signs or duration of hospitalization between the two groups. The carbetocin group exhibited significantly higher total urine output in the first 6 h compared to the oxytocin group (p=0.037). The time required to achieve urine output volumes of 500, 1,000, and 1,500 mL did not differ significantly between groups. Conclusions Carbetocin may exert a less pronounced antidiuretic effect than oxytocin following elective caesarean section in a cohort with as few confounding factors as possible. Further prospective studies are warranted to validate these findings and assess their clinical implications in postpartum hemorrhage prophylaxis.

Objectives This study evaluates the perinatal and neonatal outcomes of pregnant women with severe thrombocytopenia. Methods A cross-sectional analysis was conducted on pregnant women with platelet counts below 50 × 10 9 /L in a tertiary university hospital between January 2015 and May 2024. Patients were divided into two groups according to their lowest platelet counts. Maternal and neonatal outcomes were systematically recorded and analyzed. Results A total of 195 pregnant women were included in the study, 72 of whom were in Group A (0–30 × 10 9 /L) and 123 in Group B (30–50 × 10 9 /L). In our study, immune thrombocytopenic purpura was the most common cause of severe thrombocytopenia, accounting for 56.6 % of cases. Significant differences were observed in the rates of preterm birth (<34 weeks) and neonatal intensive care unit (NICU) admission, with higher rates in Group A (p=0.035 and p=0.05, respectively). No significant differences were found in other maternal and neonatal outcomes, including postpartum hemorrhage rates, between the two groups. Conclusions In pregnancies complicated by severe thrombocytopenia with a platelet count <30 × 10 9 /L, there is an increased risk of preterm birth before 34 weeks and NICU admission.

Objectives This study aimed to explore the relationship between the detection of misfolded proteins in urine and preeclampsia (PE) as well as adverse pregnancy outcomes. Methods A retrospective analysis was conducted on 400 pregnant women who underwent prenatal care at our hospital from January 2022 to May 2023. Demographic and clinical data were collected. The study documented the incidence of PE, positive urine misfolded protein detection rate, and the occurrence of adverse pregnancy outcomes. Factors influencing the occurrence of adverse pregnancy outcomes were also analyzed. Results Out of the 400 pregnant women, 22 cases (5.50 %) developed PE. A total of 15 cases tested positive for misfolded proteins in urine, with 14 cases (63.64 %) of PE and 1 case (0.26 %) without PE. A history of smoking/secondhand smoke exposure (OR=3.592, 95 %CI: 3.217–4.012), oligohydramnios (OR=3.992, 95 %CI: 3.363–4.739), thyroid dysfunction (OR=2.164, 95 %CI: 1.835–2.552), the use of risky medications during pregnancy (OR=3.788, 95 %CI: 3.046–4.710), mild PE (OR=4.908, 95 %CI: 3.710–6.492), severe PE (OR=6.151, 95 %CI: 3.576–10.579), and a positive test for urinary misfolded proteins (OR=5.897, 95 %CI: 4.016–8.658) were all identified as risk factors for adverse pregnancy outcomes. Conclusions The rate of positive urinary misfolded protein detection was relatively high, but there was a certain rate of false positives. Furthermore, a positive test for urinary misfolded proteins and the severity of PE was associated with an increased incidence of adverse pregnancy outcomes.

Objectives Pre-eclampsia and fetal growth restriction (FGR) is a serious complication of pregnancy. Our study aimed to identify the DEGs and pathways in the placentas of patients with pre-eclampsia and FGR and investigated the relationships between these genes and clinical characteristics to elucidate the dysregulated placental mechanisms linked to pre-eclampsia and FGR. Methods A total of 28 patients were enrolled in the study (6 individuals were selected for RNA sequencing and 22 participants was subjected to qRT-PCR). We used RNA sequencing to identify DEGs and pathways in the placenta. Ten DEGs were verified using qRT-PCR. The relationships between these DEGs and clinical characteristics were investigated using correlation analysis. Results We detected significant molecular changes in the placentas of pre-eclampsia and FGR, encompassing diverse biological processes. SYDE1 , HTRA1 , and PAPPA2 expression was significantly upregulated, whereas MYL9 , OLFML3 , VTN , and AXNA8 expression was downregulated (p<0.05). The mRNA expression levels of SYDE1 , HTRA1 and PAPPA2 displayed a positive correlation with systolic and diastolic blood pressure, LDH and LST, while exhibiting a negative correlation with fetal weight and serum albumin. And the mRNA expression levels of MYL9 , OLFML3 , VTN , and ANXA8 were significantly negatively correlated with systolic and diastolic blood pressure, LDH and LST, while exhibiting a positive correlation with fetal weight. Conclusions Our study found variations in gene expression and pathways in the placenta that may contribute to pre-eclampsia and FGR. Genes expressed in the placenta that are associated with clinical indicators could serve as potential biomarkers for assessing the occurrence of pre-eclampsia and FGR.

Objectives Pregnancy-related medical complications such as gestational diabetes mellitus (GDM) are common and associated with several obstetric and neonatal problems. There is growing evidence that microRNAs (miRNAs) are essential players in the pathophysiology of GDM. This study aimed to assess how particular miRNAs and the genes they target are expressed in GDM. Methods A GDM cell model was created using BeWo cells cultured in hyperglycemic (HG) conditions (25 mM glucose). Low-glucose (LG) conditions (5.5 mM glucose) were used for the BeWo cells in the control group. Differentially expressed genes (DEGs) in BeWo cells were identified by high-throughput sequencing and their levels verified in placental samples from GDM patients and controls using RT-PCR. Furthermore, the target genes of the DEGs were verified using dual-luciferase reporter assays. Results High-throughput sequencing revealed 220 DEGs in BeWo cells. Among these, miR-3687 was significantly upregulated, while follistatin-like 3 (FSTL3) was downregulated in BeWo cells under HG conditions. The high-throughput sequencing results were corroborated by RT-PCR, which showed that placental samples from GDM patients had significantly lower levels of FSTL3 expression and substantially higher amounts of miR-3687 expression compared to control samples. FSTL3 was established as a direct target of miR-3687 as shown by dual-luciferase reporter assays. Conclusions The increase of miR-3687 might facilitate the onset and advancement of GDM by suppressing FSTL3. This discovery offered a new perspective on the molecular underpinnings of GDM and indicated possible targets for therapeutic intervention.

Objectives To quantitatively examine placental tissue elasticity in Trisomy 21 (T21) pregnancies using shear wave elastography (SWE) and to evaluate the potential contribution of placental SWE measurements in predicting T21 fetuses. Methods This prospective case-control study was conducted at tertiary centers between January 2022 and January 2024. The study included 30 pregnant women who underwent invasive prenatal diagnostic testing and were found to have T21, along with 30 pregnant women with a normal karyotype. Central placental elasticity measurements were performed from the middle of the thickest part of the placenta, avoiding vascular areas and lacunae, and peripheral measurements were performed two centimeter (cm) medial to the lateral border of the placenta. Results The mean gestational week at measurement was 16 ± 2 weeks. Peripheral placental SWE velocity was significantly higher in the T21 group (7.4 ± 3.7 kPa vs. 4.8 ± 3.6 kPa, p=0.004). Similarly, central placental SWE velocity was also significantly higher in the T21 group (6.5 ± 2.1 kPa vs. 4.1 ± 2.6 kPa, p<0.001). In predicting T21, central placental SWE velocity had 76.7 % sensitivity and 73.3 % specificity with a cut-off value of ≥4.35 kPa (p<0.001), and peripheral had 70 % sensitivity and 66.7 % specificity with a cut-off value of ≥4.65 kPa (p=0.004). When central placental SWE velocity was ≥4.35 kPa, the risk of T21 was increased 6.64-fold, even after adjusting for maternal age, which is a well-known risk factor for T21. Conclusions Placental stiffness was significantly higher in T21 in both central and peripheral areas. Placental elasticity, especially in the central part, may be a potential marker for T21.

Objectives To evaluate the rate of documented penicillin allergies in obstetric patients and to estimate the proportion of patients receiving inappropriate alternative intrapartum group B Streptococcus (GBS) prophylaxis. Methods This was a retrospective cohort study of patients delivering at Denver Health Medical Center (DHMC) between April 27, 2017 and October 31, 2022. The study included all patients with documented penicillin allergy and GBS positive status during routine prenatal care. Records were reviewed for allergy severity/risk and antibiotic administered for GBS prophylaxis. Allergy severity/risk was based on whether there was a documented reaction in the electronic health record and the presence or absence of anaphylaxis, angioedema, respiratory distress, or urticaria. Patients were classified as receiving appropriate or inappropriate intrapartum antibiotic prophylaxis based on their allergy risk stratification and whether they received standard (e.g. penicillin, cefazolin) or alternative (e.g. clindamycin, vancomycin) antibiotics. The primary outcome was inappropriate prophylaxis, defined as receiving an alternative antibiotic in the setting of a low-risk penicillin allergy. Secondary maternal and neonatal outcomes were abstracted and compared based on appropriateness of antibiotic selection. Results There were 18,931 unique patient encounters during the study period, of whom 1,262 (6.7 %) had a documented penicillin allergy. Of patients with penicillin allergies, 196 were GBS-colonized. Of the 86 GBS-colonized patients with low-risk penicillin allergies, 54 (62.8 %) received inappropriate antibiotic prophylaxis (i.e. received alternative antibiotics despite a low-risk allergy). Fewer than 7 % of pregnant patients developed complications, including chorioamnionitis, endometritis, or surgical site infection within 30 days. Only one neonate was diagnosed with GBS bacteremia. Conclusions More than half of GBS-colonized patients with low-risk penicillin allergies at our institution received inappropriate intrapartum antibiotic prophylaxis. These data support the need for improved documentation of allergy type and severity and antibiotic selection to expand adherence to guideline recommendations.

Objectives Postpartum mood disorders affect approximately 20 % of postpartum women. This study examines the association between postpartum mood disorders and preeclampsia with severe features (SPE), postpartum hemorrhage (PPH), very/extremely preterm delivery (EPTD), and fetal congenital malformations (FCM). Methods A retrospective chart review was conducted at a large southeastern quaternary academic hospital using ICD-10 codes for the four high-risk perinatal complications. Medical records included 3,652 cases and 750 normal patient comparisons (NPC). Inclusion criteria: 1) prenatal visit at the institution, 2) live delivery at the institution, 3) postpartum visit at the institution, and 4) completed Edinburgh Postnatal Depression Scale (EPDS) at postpartum visit. EPDS scores≥12 and EPDS-3A scores≥5 were considered positive for depression and anxiety symptoms, respectively. Results Five cohorts were analyzed [NPC (n=200), SPE (n=150), PPH (n=153), EPTD (n=102), and FCM (n=200)]. Independent sample t-tests revealed significant differences in mean EPDS scores between NPC and EPTD (p<0.001) and FCM (p=0.014) and in mean EPDS-3A scores between NPC and EPTD (p<0.001) and PPH (p=0.011). Conclusions EPTD, FCM, and PPH are diagnoses associated with elevated EPDS and/or EPDS-3A scores. Increased mood surveillance in patients with these complications is warranted. Understanding the association of these conditions with increased depression and anxiety symptoms will allow for earlier identification and treatment of postpartum mood disorders.

Objectives The aim of this study was to compare the fetal thymus size measured in the second and third trimester of pregnancy in underweight women and women with normal weight. We hypothesized that the low maternal weight would affect the fetal thymus size, as maternal health and nutrition during pregnancy affect fetal development, including that of the fetal immune system. Methods The fetal thymus size was retrospectively assessed by determining the thymic-thoracic ratio in 77 pregnancies of underweight women (study group) and 85 pregnancies of women with normal weight (control group) between the 19th and 34th week of pregnancy. The anteroposterior thymic diameter and the intrathoracic mediastinal diameter were measured in the three-vessel view acquired from routine echocardiograms. The thymic-thoracic ratio was calculated by dividing the anteroposterior thymic diameter with the intrathoracic mediastinal diameter. Additionally, we compared the descriptive data between the two groups, such as gestational age at screening and at birth, birth weight, umbilical artery pH and APGAR-score after 5 min. Results The mean fetal thymic-thoracic ratio in underweight women was not significantly different to that in normal weight pregnancies (0.374 vs. 0.363). However, the average gestational age at birth, birth weight and APGAR-score at birth were lower in the group of underweight women. Conclusions There is no evidence that low maternal weight influences fetal thymus size during pregnancy. The differences we observed concerning fetal weight at birth, gestational age at delivery, APGAR-Score and birth weight percentile confirm the results of previous studies.

Objectives Normal fetal echocardiography ratios reflect blood flow balance and developmental patterns, providing a basis for more accurate diagnosis and prediction of congenital heart disease in fetuses. Despite its significance, standardized studies with ample samples are lacking. We aim to establish reference ranges for fetal cardiac structural parameters and hemodynamics using extensive multicenter data, including 11 ratios, and to clarify how these ratios change with gestational age. Methods This is a multicenter cross-sectional retrospective study. 23,313 normal fetal echocardiographic examinations were enrolled from three medical centers. Analysis included 11 fetal cardiac-related ratios, such as right/left heart diameter ratio, mitral and tricuspid valve E/A-wave velocity ratio. To determine the reference ranges for various ratios across different gestational ages, a nonparametric quantile regression model, which does not presuppose normality, was utilized. The study investigated how the ratios change with gestational age by examining nonparametric regression plots and their first and second derivatives. Results We established normal percentile reference ranges for 11 ratios at each gestational day. Analysis of ratio changes across gestation reveals several key patterns: The right heart system consistently dominates, with the right heart/left heart internal diameter ratio accelerating from 21.7 weeks of gestation; throughout fetal development, the E/A ratio of the mitral and tricuspid valves initially remains below one but increases progressively with gestational age, both reaching their maximum growth rates at week 25.7. Conclusions This study provides new references for routine obstetric screening, may enhance the understanding of the growth and developmental patterns of normal fetal hearts.

Objectives This study investigates the relationship between fetal lung elastography values and the development of postpartum respiratory distress syndrome (RDS) in late preterm neonates. Methods A total of 88 singleton pregnancies between 34 and 37 weeks of gestation were analyzed. Fetal lung and liver elasticity measurements were performed using 2D shear wave elastography (SWE). Lung and liver elasticity values were compared between neonates who developed RDS and those who did not. The lung-liver elastography (LLE) ratio was also calculated. Results The minimum, maximum, and median lung elastography values were significantly higher in neonates with RDS compared to the control group (p<0.05). However, liver elastography values were similar between groups. The LLE ratio was also significantly higher in the RDS group (p=0.014). Additionally, neonates with RDS had lower APGAR scores, higher NICU admission rates, and increased need for respiratory support. Conclusions Higher fetal lung elastography values and LLE ratios are associated with an increased risk of RDS in late preterm neonates. Fetal lung elastography may serve as a valuable non-invasive tool for predicting neonatal respiratory complications, potentially guiding perinatal management and treatment strategies. Further multicenter studies are needed to validate these findings.

Objectives Infants with Down’s syndrome (DS) can suffer from lung hypoplasia. Our aim was to determine if the chest radiographic thoracic area (CRTA) on day one of life differed between infants with DS compared to term controls without respiratory disease and whether in infants with DS, the CRTA was related to a longer duration of ventilation and supplemental oxygen therapy. Methods A review of infants with DS born between 2012 and 2023 at King’s College Hospital NHS Foundation Trust, London, UK was conducted. The control group consisted of term, newborn infants matched for birth weight and ventilated for poor respiratory drive at birth. Chest radiographs on day one were analysed and the highest CRTA for each infant was included in the analysis. Results The 40 infants with DS (18 male) had significantly lower median (IQR) CRTA [1,922 (1,571–2,261) mm 2 ] compared to 80 controls [2,495 (2,108–2,908) mm 2 , p<0.001]. The CRTA was not related to a longer duration of invasive ventilation, a longer period of supplemental oxygen requirement and was not different in infants with DS with or without significant congenital heart disease or gastrointestinal atresia. Conclusions Newborn infants with Down’s syndrome had lower chest radiographic thoracic area compared to healthy term controls, but this finding was not associated with clinical indices of lung disease severity.