BMC Pregnancy And Childbirth[JOURNAL]
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200 papers
Complex postpartum fever caused by ovarian vein thrombophlebitis combined with acute pyelonephritis: a rare case report.
Chen W, Lin Q, Hong Q … +3 more , Wang Q, Jiang L, Ao W
BMC Pregnancy Childbirth · 2026 Jul · PMID 42402563 · Full text
BACKGROUND: Ovarian vein thrombophlebitis (OVT) is a rare but serious postpartum complication. This report presents a case of OVT with acute pyelonephritis successfully managed at our hospital. By summarizing the clinica...
BACKGROUND: Ovarian vein thrombophlebitis (OVT) is a rare but serious postpartum complication. This report presents a case of OVT with acute pyelonephritis successfully managed at our hospital. By summarizing the clinical course, diagnostic process, and treatment-alongside a literature review-it aims to improve clinical recognition and management of this uncommon condition. CASE PRESENTATION: A 28-year-old woman in the early postpartum period was admitted to the Department of Obstetrics and Gynecology with persistent high fever and flank pain. Diagnostic evaluations included contrast-enhanced abdominal computed tomography (CT), urinary tract ultrasonography, and routine blood and urine tests. A multidisciplinary team formulated an individualized treatment plan consisting of right-sided ureteral double-J stent placement, antimicrobial therapy with meropenem, anticoagulation with low-molecular-weight heparin, and supportive care including fluid resuscitation. Based on clinical symptoms, physical examination, and imaging findings, a diagnosis of ovarian vein thrombophlebitis (OVT) complicated by acute pyelonephritis was established. The patient responded well to the comprehensive treatment regimen, with significant reductions in inflammatory markers-white blood cell count (WBC), neutrophil percentage (NEUT), C-reactive protein (CRP), and procalcitonin (PCT). Coagulation function normalized, and both fever and flank pain were notably alleviated. She achieved full recovery after 15 days of hospitalization and showed no abnormalities at the 42-day postpartum follow-up. CONCLUSIONS: OVT complicated with acute pyelonephritis often manifests as persistent postpartum fever and flank pain, with poor response to first- and second-line antibiotics. Diagnosis relies on contrast-enhanced abdominal CT and urinary tract ultrasound, supplemented by coagulation studies. Early ureteral double-J stent placement, combined with third-line antibiotic therapy and anticoagulation, is essential for effective infection control and prevention of thrombus progression. In postpartum patients with unexplained fever and flank pain, clinicians should maintain a high index of suspicion for OVT and complicated urinary tract infections.
Investigating social appearance anxiety, fear of negative evaluation and body image and the use of personal care and cosmetic products during pregnancy.
Öztürk S, Nacar G, Ti̇mur Taşhan S
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401928 · Full text
BACKGROUND: Women's rate of personal and cosmetic care product use have increased with the societal increases in social appearance anxiety, fear of negative evaluation, and body image concerns. AIMS: The purpose of this...
BACKGROUND: Women's rate of personal and cosmetic care product use have increased with the societal increases in social appearance anxiety, fear of negative evaluation, and body image concerns. AIMS: The purpose of this study is to determine social appearance anxiety, fear of negative evaluation and body image and the use of personal care and cosmetic products during pregnancy. METHODS: This study used a cross-sectional, correlational and descriptive design. It was conducted with pregnant women who sought treatment in the gynecology outpatient clinics of a state hospital. The sample of the study consisted of 378 pregnant women. Data were collected through the Personal Information Form, the Social Appearance Anxiety Scale (SAAS), the Fear of Negative Evaluation Scale (FNES), and the Body Image Concerns during Pregnancy Scale (BICDPS). RESULTS: One out of every five pregnant women in this study changed the personal care/cosmetic product they used after learning about their pregnancy. The number of personal care and cosmetic products used was found to increase with the increase in the BICDPS avoidance and social concerns, concerns about weight gain, and concerns about the future sub-scales mean scores (p < 0.05). In addition, the increase in BICDPS concerns about weight gain and concerns about the future sub-scale mean scores and the increase in FNES mean scores indicated an increase in the number of cosmetic products (p < 0.05). SAAS mean score was found to increase with the increase in the number of personal care products used (p < 0.05). CONCLUSION: This study found that pregnant women's rate of personal and cosmetic care product use increased with the increase in social appearance anxiety, fear of negative evaluation, and body image concerns. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Gynecology nurses can identify the use of cosmetics and personal care products during pregnancy and reduce the use of these products.
EMBRACE COMPASS: protocol for a multi-country cross-sectional comparative analysis of pregnancy and postnatal care architecture.
Arechvo A, Crisan A, Wang Y … +6 more , Bornstein E, Bhorat I, Da Silva Costa F, Nicolaides KH, Car J, EMBRACE COMPASS Collaborator Group
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401897 · Full text
BACKGROUND: Maternal morbidity and mortality remain major global health challenges, with substantial variation in maternity care delivery across health systems. Although clinical guidelines are widely available, there is...
BACKGROUND: Maternal morbidity and mortality remain major global health challenges, with substantial variation in maternity care delivery across health systems. Although clinical guidelines are widely available, there is limited systematic, multi-country mapping of maternity care systems as integrated architectures. Evidence linking system design and implementation to population outcomes is also limited. This study aims to compare maternity care systems across countries for gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, and uncomplicated pregnancy using a structured, multi-layered care architecture framework. METHODS: This is a multi-country, cross-sectional, mixed-methods comparative study including twenty countries across all World Health Organization regions and income groups, selected using purposive sampling. Data will be collected using a standardised instrument with more than 140 items mapped to a nine-layer care architecture framework, covering policy, clinical standards, guidelines, models of care, care pathways, clinical protocols, digital systems, patient experience, and financing. Data sources will include structured country submissions, systematic document review, and validation interviews with clinicians and policymakers. Each domain will be independently scored by two reviewers using a four-point ordinal scale, with assessment of inter-rater reliability. Country profiles will be validated through member checking and triangulation of documentary and interview data. Comparative analyses will include descriptive profiling, cross-country comparisons, clustering to identify system typologies, and gap analysis against international benchmarks. Implementation and equity dimensions will be assessed using established frameworks, and physical activity guidance will be examined as a cross-cutting domain. Exploratory ecological analyses will assess associations between system characteristics and publicly available outcomes, including maternal mortality, preterm birth, stillbirth, and caesarean section rates, using regression models. A structured consensus process will be used to develop minimum care architecture standards and harmonisation recommendations. DISCUSSION: This study will provide a structured and reproducible approach to characterising and comparing maternity care systems globally. By identifying variation in system design, implementation, and equity considerations, the findings will inform policy, support harmonisation of care, and guide improvements in maternal and perinatal outcomes across diverse settings. REGISTRATION: Open Science Framework.
Cervical cerclage outcomes by indication and cervical length across gestational-age thresholds: a historical cohort study.
Batman A, Azman MK, Çaltek HÖ … +4 more , Konu A, Okşen E, Türkoğlu A, Erenel H
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401881 · Full text
BACKGROUND: Cervical cerclage reduces the risk of preterm birth, but factors associated with its success may not be uniform. Among singleton pregnancies with ultrasound- or physical examination-indicated cerclage (no his...
BACKGROUND: Cervical cerclage reduces the risk of preterm birth, but factors associated with its success may not be uniform. Among singleton pregnancies with ultrasound- or physical examination-indicated cerclage (no history-based indication), we examined whether factors associated with delivery differ by gestational-age threshold. METHODS: This single-center historical cohort included 114 women undergoing cerclage between May 2020 and December 2025: ultrasound-indicated with cervical length 10 to < 20 mm (Group 1, n = 41) or < 10 mm (Group 2, n = 32), and physical examination-indicated cervical dilatation (Group 3, n = 41). All cerclages used the McDonald technique with polypropylene monofilament suture. The primary outcome was gestational age at delivery, assessed at ≥ 34, < 32, and < 28 weeks. Firth penalized multivariable logistic regression evaluated study group, maternal age, and gestational age at cerclage as primary covariates; post-cerclage cervical length was analyzed separately as a secondary post-treatment-adjusted variable. All models were exploratory, and p values were nominal. RESULTS: In these exploratory models, factors associated with delivery differed across thresholds. For delivery ≥ 34 weeks, gestational age at cerclage was the only covariate independently associated with the outcome (aOR 1.28 per week, 95% CI 1.04 to 1.59; p = 0.021). For delivery before 32 weeks (aOR 2.96, 95% CI 1.08 to 8.66; p = 0.034) and before 28 weeks (aOR 9.36, 95% CI 1.98 to 91.11; p = 0.003), physical examination-indicated cerclage was the only covariate that reached significance; 11 of the 14 deliveries before 28 weeks occurred in this group, so this estimate is imprecise and near-separating. The numerically higher rate of delivery ≥ 34 weeks in Group 2 than Group 1 (78.1% vs. 70.7%) was not statistically significant. Apparent discrimination was moderate (AUC 0.69 to 0.77), without internal validation. CONCLUSIONS: In this exploratory single-center cohort, the factors associated with delivery varied with the gestational-age threshold examined. Near term, later gestational age at cerclage was associated with delivery ≥ 34 weeks; at earlier thresholds, physical examination-indicated cerclage identified a higher-risk group for very and extreme preterm delivery, although these estimates were imprecise and partly confounded by indication severity and co-interventions. Findings should be interpreted as hypothesis-generating and require confirmation in larger prospective studies.
Health literacy and attitudes toward prenatal screening tests among pregnant women: a cross-sectional study in Turkey.
Hacıvelioğlu D, Odabaşı NÇ, Hasdemir PS
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401867 · Full text
BACKGROUND: Due to the widespread use of screening methods and the increase in advanced age pregnancies, interest in prenatal screening tests is increasing day by day. In Türkiye, the Ministry of Health recommends that p...
BACKGROUND: Due to the widespread use of screening methods and the increase in advanced age pregnancies, interest in prenatal screening tests is increasing day by day. In Türkiye, the Ministry of Health recommends that pregnant women be informed about prenatal screening tests and ultrasonographic examinations for fetal anomalies and chromosomal aneuploidy. Although these tests are not mandatory, it is important for pregnant women to understand their purpose and scope before making a decision. This requires having sufficient health literacy (HL). This study aimed to examine the HL levels of pregnant women and their perspectives on prenatal screening tests. METHODS: This cross-sectional study was conducted with 477 pregnant women in the pregnancy follow-up clinic of a university hospital in Turkey. Data were obtained through the Descriptive Information Form-comprising items on sociodemographic characteristics, pregnancy, and prenatal screening-and the Health Literacy Scale (adaptation from HLS-EU-47). RESULTS: The average age of pregnant women was 27.55 ± 5.56. Pregnant women were most familiar with the double screening test (25.3%). Pregnant women most frequently received information or counseling on prenatal screening tests from obstetricians (44.2%) and the internet/social media (26.3%). The mean HL score was 116.11 ± 11.47, with higher levels observed among those without consanguinity with their spouses and without a family history of hereditary diseases. HL also differed significantly by regular antenatal follow-up, screening practices, and certain sociodemographic factors (p < 0.05). Higher HL was associated with greater uptake of screening. Pregnant women who underwent screening tests and those who wanted to undergo screening tests had higher HL levels. CONCLUSIONS: Findings suggest that strategies to improve pregnant women's HL should focus on those with low socioeconomic status and advanced age. Integrating HL assessment into routine primary care monitoring and providing visually supported, simplified education on prenatal screening may be beneficial. Midwives should strengthen communication skills suited to pregnant women's HL levels. Further research is recommended on the links between HL, screening tests, and related counseling and interventions among different groups.
Health system strengthening to reduce maternal and perinatal deaths in Central Region of Ghana - project approach.
Owusu-Sarpong A, Sarpong G, Anane A … +3 more , Mensah V, Agbeno EK, Oduro AR
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401857 · Full text
BACKGROUND: Institutional maternal and perinatal outcomes are highly specific to local contextualized conditions and are suited to inform local policy. As institutional delivery increases, maternal health events are more...
BACKGROUND: Institutional maternal and perinatal outcomes are highly specific to local contextualized conditions and are suited to inform local policy. As institutional delivery increases, maternal health events are more likely to occur in facilities than at home. METHODS: This was a before-after impact evaluation study through the implementation of a 3-year quality improvement project undertaken in Central Region. The goal was to reduce institutional maternal mortality ratio and perinatal mortality rate over a 3-year period from 2021 to 2023 with 2020 as a baseline year. Baseline assessment was conducted by reviewing 2020 maternal death audit reports to identify key challenges associated with maternal deaths. Interventions were drawn to address identified challenges by key stakeholders. Sensitization meetings were held with stakeholders, health managers and health staff to discuss the interventions and solicited their support. Interventions implemented were life-saving skills and safe motherhood trainings for health staff across the region, introduction of maternal death tracker to improve surveillance on maternal death, clinical supervision of health staff at the peripheral level by specialist through telemedicine using WhatsApp platforms from 2021 to 2023. Baseline indicators were collected from the District Health Information Management System-2 (DHIM2) in 2020. The outcome indicators were improved family planning coverages, increased skilled delivery rates and reduction in maternal mortality ratio and perinatal mortality rates. Process indicators were proportion of practicing midwives and clinicians trained in life saving skills, number of health centers conducting basic emergency obstetric care signal functions, percentage of audited maternal deaths entered DHIMS2. RESULTS: Over the course of the project, 4,800 health staff were trained, skilled birth rate improved from 61.6 to 63.9%, family planning acceptor rate from 28.5 to 45.1% and reported maternal deaths audited improved from 78.7 to 100%. The implementation of institutional audit recommendations also improved from 20 to 72%. Institutional maternal mortality ratio declined by 25.3% and neonatal deaths by 45.2%. CONCLUSIONS: Quality improvement methods using the project approach to strengthen maternal health services can lead to improve mother and baby health outcomes. This approach when scaled up nationally may help increase the chances of meeting the sustainable development goal three, I recommend the implementation of the interventions to policymakers such as the Ministry of Health to support in reducing institutional maternal and perinatal mortalities.
Reproductive tract and follicular fluid microbiota and probiotic interventions in IVF/ICSI outcomes: a systematic review.
Ma G, Zeng R, Cai R … +4 more , He B, Han J, Gao R, Qin L
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401851 · Full text
BACKGROUND: To investigate the associations of reproductive tract and follicular fluid microbiota composition, microbial diversity, and probiotic interventions with pregnancy outcomes after in vitro fertilization (IVF) o...
BACKGROUND: To investigate the associations of reproductive tract and follicular fluid microbiota composition, microbial diversity, and probiotic interventions with pregnancy outcomes after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 2000 to August 2025, with manual screening of reference lists. Original human studies on women undergoing IVF/ICSI reporting reproductive tract or follicular fluid microbiota, pregnancy outcomes, or probiotic interventions were included, encompassing randomized controlled trials and observational studies. Two reviewers independently screened studies, extracted data, and assessed quality using RoB 2.0, ROBINS-I, and JBI tools. Due to heterogeneity in study designs, sampling sites, and microbiota methods, a qualitative synthesis was performed. RESULTS: Among 2546 identified records, 40 studies met the inclusion criteria. Most studies consistently reported that a Lactobacillus-dominant reproductive tract microbiota, particularly Lactobacillus crispatus, was associated with higher implantation, clinical pregnancy, and live birth rates, whereas non-Lactobacillus or pathogen-enriched microbiota profiles were linked to poorer reproductive outcomes. Microbial diversity alone showed inconsistent associations with IVF/ICSI outcomes. Evidence regarding the influence of follicular fluid microbiota on pregnancy outcomes remains limited. Longer-term or individualized probiotic regimens appeared to increase Lactobacillus abundance and were associated with improved reproductive outcomes, whereas short-term interventions demonstrated minimal benefit. CONCLUSION: Species-level and site-specific reproductive tract microbiota profiles appear to better predict assisted reproductive technology outcomes than diversity measures alone. Personalized or longer-duration probiotic strategies may hold therapeutic potential; however, current evidence remains limited and heterogeneous. Well-designed longitudinal and site-specific trials are required to clarify the effectiveness of microbiota-targeted interventions in IVF/ICSI.
Determining the cognitive-psychological predictors of pregnancy-related anxiety among pregnant women.
Mohammad Hosseinzadeh M, Maheri M
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401845 · Full text
BACKGROUND: Pregnancy-related anxiety can adversely affect maternal and fetal health; therefore, understanding its related factors is essential. This study aimed to determine the cognitive-psychological predictors of pre...
BACKGROUND: Pregnancy-related anxiety can adversely affect maternal and fetal health; therefore, understanding its related factors is essential. This study aimed to determine the cognitive-psychological predictors of pregnancy-related anxiety among pregnant women. METHODS: This cross-sectional study was conducted on 400 pregnant women who were covered by urban comprehensive health service centers in Urmia. Data were collected using a demographic questionnaire; the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R2); the Edinburgh Postnatal Depression Scale (EPDS); the Multidimensional Scale of Perceived Social Support (MSPSS); the Childbirth Self-Efficacy Inventory (CBSEI); and the Maternal Health Literacy and Pregnancy Outcome Questionnaire (MHLAPQ). The data were analyzed using SPSS version 16. A p-value of less than 0.05 was considered statistically significant. RESULTS: The mean age of participants was 26.53 ± 4.87 years. The mean pregnancy-related anxiety score was 28.03 ± 9.08. Among the subscales of pregnancy-related anxiety, the lowest mean score was associated with concerns about own appearance, while the highest mean score was linked to fear of childbirth. Depression during pregnancy (B = 0.821, β = 0.523, p < 0.001) and childbirth self-efficacy (B = - 0.048, β = -0.176, p < 0.001) were significant predictors of pregnancy-related anxiety, whereas perceived social support and maternal health literacy were not significant predictors. The cognitive-psychological variables examined explained approximately 34% of the variance in pregnancy-related anxiety. CONCLUSIONS: The results showed a moderate level of pregnancy-related anxiety in the study population. Therefore, it is recommended to incorporate early screening for pregnancy-related anxiety and its related factors into routine care. Furthermore, appropriate interventions should be implemented to reduce pregnancy-related anxiety by addressing its predictors.
Neonatal and maternal outcomes following transfer of vitrified embryos compared with slow-frozen and fresh embryos: a retrospective study in singletons.
Ying Y, Chen J, Huang Y … +3 more , Shen X, Lin Y, Zhang D
BMC Pregnancy Childbirth · 2026 Jul · PMID 42401823 · Full text
PURPOSE: Embryo cryopreservation plays an essential role in assisted reproductive technology (ART). Vitrification has gradually replaced slow-freezing of embryos. In this study we investigated the effects of embryo vitri...
PURPOSE: Embryo cryopreservation plays an essential role in assisted reproductive technology (ART). Vitrification has gradually replaced slow-freezing of embryos. In this study we investigated the effects of embryo vitrification on neonatal and maternal health. METHODS: The retrospective study involved 19,752 in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles performed at the Reproductive Medicine Center in Women's Hospital, School of Medicine, Zhejiang University between October 2014 and September 2019. 7707 singletons got live birth, among which 427 were born after transfer of vitrified embryos, 3737 slow-frozen and 3543 fresh. Neonatal and maternal outcomes of singleton liveborns following transfer of vitrified were compared with slow-frozen and fresh embryos. Logistic regression analysis was conducted to adjust for possible confounders. RESULTS: Transfer of vitrified embryos was comparable with slow-frozen embryos in low birth weight, macrosomia, small/large for gestational age (SGA/LGA) and birth defects. When compared with transfer of fresh embryos, transfer of vitrified embryos was associated with a higher risk of hypertensive disorders in pregnancy (HDP) aOR 7.12 (3.82-13.06), postpartum hemorrhage (PPH) aOR 6.81 (3.15-14.48) and cesarean section aOR 1.67 (1.34-2.10). No statistical differences were found for birth defects. There was a rising trend in birth weight, fetal macrosomia and LGA, as well as a declining trend in LGA after transfer of vitrified embryos compared to fresh embryos, though no statistical differences were found for risks. CONCLUSION: Transfer of vitrified embryos was comparable in birth weight and birth defects with slow-frozen embryos. When compared with fresh embryo transfer, transfer of vitrified embryos showed higher risks of HDP, PPH and cesarean section, and a rising trend in birth weight, which needs further follow-up. TRIAL REGISTRATION: IRB-20190052, 6th June 2019 retrospectively registered.
Uterine cystic adenomyoma arising from cesarean scar diverticulum: a case report and literature review.
Dan Q, Kong F, Sun R … +2 more , Chen Y, Wang Y
BMC Pregnancy Childbirth · 2026 Jul · PMID 42399854 · Full text
BACKGROUND: With the rising rate of cesarean section delivery worldwide, the development of cesarean scar diverticulum (CSD) is increasingly observed, with a prevenance ranging from 24% to 70%. CSD is associated with abn...
BACKGROUND: With the rising rate of cesarean section delivery worldwide, the development of cesarean scar diverticulum (CSD) is increasingly observed, with a prevenance ranging from 24% to 70%. CSD is associated with abnormal uterine bleeding, chronic pelvic pain, cesarean scar pregnancy, and infertility. Furthermore, a CSD can present as a pelvic mass that causes diagnostic dilemma. Herein, we report a rare case of uterine cystic adenomyoma (UCA) arising from CSD and review a series of similar diseases to improve the understanding of CSD-associated mass. CASE PRESENTATION: A 37-year-old woman presented with menorrhagia after her two cesarean deliveries. Transvaginal sonography (TVS) revealed a huge, thick-wall, heterogeneously hypoechoic mass at the anterior lower uterine segment, which was connected to uterine cavity and protruded outside of the uterus. No specific ultrasound diagnosis was made although it was in favor of benign lesion from prior cesarean scar. Hysteroscopic and laparoscopic exploration was decided. The operation verified a CSD at previous cesarean scar. Postoperative pathology revealed a CSD, uterine cystic adenomyoma (UCA), and diffuse smooth muscular hyperplasia, in favor of the diagnosis of CSD accompanied by UCA. The patient's menstrual condition improved after surgery. CONCLUSIONS: CSD-associated mass is very rare. In patients with a prior cesarean section, a mass in the lower uterine segment, especially with a cavity connection, should raise suspicion for a CSD-associated lesion. When TVS is inclusive, pelvic MRI serves as a diagnostic adjunct. For management, the combined hysteroscopic-laparoscopic approach allows for precise excision of the mass and concurrent repair of the CSD in a single procedure. Future efforts should focus on refining the classification of these masses and standardizing management procedures to optimize symptomatic and reproductive outcomes.
A core outcome measurement set for hyperemesis gravidarum research: a consensus study.
Jansen LAW, van der Minnen LM, Blaauwgeers A … +9 more , Dean C, Gauw N, Van't Hooft J, Maslin K, Nordin L, Ostenfeld A, Trovik J, Grooten IJ, Painter RC
BMC Pregnancy Childbirth · 2026 Jul · PMID 42399837 · Full text
BACKGROUND: Outcome reporting in hyperemesis gravidarum (HG) research lacks standardization, which hampers the aggregation of data. A core outcome set (COS) for HG research has been developed to increase standardization....
BACKGROUND: Outcome reporting in hyperemesis gravidarum (HG) research lacks standardization, which hampers the aggregation of data. A core outcome set (COS) for HG research has been developed to increase standardization. While a COS represents which key outcomes should be measured, it does not describe how and when they should be measured. Our aim was to develop a consensus-based core outcome measurement set for HG complementing the existing COS for HG. METHOD: This study included multiple phases: (1) systematic review to identify all existing outcome measurement instrument (OMI)s in HG research; (2) a consensus meeting with the steering committee of this study to vote for one best OMI per outcome; (3) a modified Delphi consultation survey of at least 100 stakeholders including patients, obstetric healthcare professionals, other healthcare professionals and researchers to achieve consensus on one OMI per outcome. RESULTS: The literature review identified 362 unique OMIs in 461 studies. The modified Delphi consultation round included 155 stakeholders including researchers (12.3%), women or families with lived experiences (51%), obstetric healthcare professionals (20%), and other healthcare professionals (12.9%) representing 10 countries. We achieved consensus (> 70% agreement) on all 24 OMIs presented during the Delphi survey including validated questionnaires such as the Pregnancy Unique Quantification of Emesis 24 h (PUQE-24) score and the EQ-5D-5 L as well as standardized definitions for outcomes such as preterm birth and babies small-for-gestational-age. Consensus was achieved on an OMI for each outcome included in the COS. CONCLUSIONS: We developed a consensus-based set of core outcome measurements to record the previously established COS for studies in HG. This core outcome measurement set describes how outcomes included in the COS should be measured and reported. The COS and core outcome measurement set should be used in all future HG trials. This will help further standardize outcome selection, collection, and reporting in HG trials.
Development and validation of machine learning models for obstructive sleep apnea risk stratification in high-risk pregnant women.
Wang Y, Wang K, Niu X … +8 more , Wang X, Hu Z, Shen N, Jiang T, Tong T, Gao H, Ma J, Zhang L
BMC Pregnancy Childbirth · 2026 Jul · PMID 42399832 · Full text
BACKGROUND: Obstructive sleep apnea (OSA) affects approximately 15% of pregnancies and is associated with adverse maternal and fetal outcomes. Although polysomnography (PSG) is the diagnostic gold standard, increasing cl...
BACKGROUND: Obstructive sleep apnea (OSA) affects approximately 15% of pregnancies and is associated with adverse maternal and fetal outcomes. Although polysomnography (PSG) is the diagnostic gold standard, increasing clinical demand creates substantial bottlenecks in manual PSG scoring and specialist review. Conventional screening tools often show limited discriminative ability in high-risk referred populations. Therefore, optimized risk stratification models are needed to streamline clinical workflows, prioritize diagnostic resource allocation, and facilitate timely intervention for high-risk pregnant patients. METHODS: This retrospective observational cohort study recruited pregnant women with suspected OSA who underwent level 2 portable PSG. Six machine learning algorithms, including XGBoost, logistic regression, GBM, neural networks, KNN, and AdaBoost, were constructed based on integrated clinical and oximetry features. Feature importance screening and DeLong's test-based pairwise comparison were performed to determine the optimal feature combination for model construction. The primary outcome was any OSA defined by an apnea-hypopnea index (AHI) ≥ 5 events/h, while the secondary outcome was moderate-to-severe OSA (AHI ≥ 15 events/h). All models were optimized using 10-fold cross-validation and externally validated on an independent testing set. Model performance was comprehensively assessed via receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). RESULTS: Among the 667 enrolled participants, 305 (45.7%) were diagnosed with OSA. The 3% oxygen desaturation index, lowest SpO2, body mass index, waist circumference, and abdominal circumference were identified as core predictive variables. For the primary screening of any OSA, logistic regression and neural networks achieved robust and comparable discriminative performance; the logistic regression model attained a testing-set AUC of 0.872 with a sensitivity of 78.0%. For moderate-to-severe OSA prediction, AdaBoost and GBM exhibited excellent predictive efficacy, with testing-set AUCs of 0.956 and 0.955, respectively. DCA confirmed that the established models yield favorable clinical net benefit across broad risk threshold ranges, enabling optimized clinical screening and priority referral strategies. CONCLUSIONS: This machine learning-based risk stratification framework demonstrates promising diagnostic performance for identifying OSA in symptomatic pregnant women under clinical referral. Leveraging structured medical records incorporating sleep history and physical measurements, this tool serves as an auxiliary triage strategy to assist clinical decision-making. The proposed models may help identify high-risk patients for expedited PSG assessment, which has the potential to optimize diagnostic workflows and improve resource allocation in specialized obstetric sleep medicine services.
The acceptability and feasibility of a randomised controlled trial of serial prophylactic exchange blood transfusion versus usual care in pregnant women with sickle cell disease: a qualitative study.
Oakley LL, McDermott C, Robinson V … +3 more , Joseph J, Oteng-Nim E, Brien SB
BMC Pregnancy Childbirth · 2026 Jul · PMID 42399799 · Full text
BACKGROUND: Pregnancy in women living with sickle cell disease (SCD) is associated with increased risk of morbidity and mortality for mother and baby. Outside of pregnancy, serial prophylactic exchange blood transfusion...
BACKGROUND: Pregnancy in women living with sickle cell disease (SCD) is associated with increased risk of morbidity and mortality for mother and baby. Outside of pregnancy, serial prophylactic exchange blood transfusion (SPEBT) has proven efficacy as a treatment for acute SCD complications, however, there is inadequate evidence for the safety and benefit for SCD during pregnancy. AIM: To explore health professionals and women's view on the acceptability and feasibility of a randomised control trial of SPEBT versus usual care in pregnant women with SCD (Transfusion Antenatally in Pregnant women with SCD-TAPS2). METHODS: Semi-structured telephone interviews were conducted with TAPS2 trial participants, trial decliners and clinical staff working on the TAPS2 trial. Interviews were analysed using reflexive thematic analysis. RESULTS: We interviewed 19 trial participants, 12 trial decliners and 15 clinical staff. Three overarching themes were identified. First, factors affecting patient decisions on participation. These included personal benefit, particularly the hope that SPEBT would lead to a healthier pregnancy-and altruistic motivations to help other women with SCD. Factors deterring women from participating included concerns about potential risks of SPEBT, for example infection, side effects, or transfusion reactions. Second, experiences of the TAPS2 trial varied. Participants allocated to SPEBT recounted perceived health benefits as well as 'expected' side effects. The time and cost involved in attending transfusion sessions had been difficult for some. Clinical staff at some sites reported that pressures on local apheresis capacity made delivering the intervention challenging. Third, interviews provided recommendations to inform the design of a future definitive RCT of SPEBT versus usual care, including suggestions to maximise participant recruitment. Suggested strategies included the provision of accessible, evidenced-based patient education to patients, partners and families to enable informed decision-making. There was strong support for including an observational arm in any future trial to enable patients unwilling, or unable, to be randomised to take part. CONCLUSION: Patients' views on blood transfusions emerged as a key determinant in whether they chose to take part in this feasibility trial. Addressing pregnant SCD women's treatment concerns and preferences is key to maximising recruitment and retention in future trials. Addressing information gaps or misinformation through accessible patient education is needed. Including an observational study arm as part of a future definitive RCT, along with other highlighted strategies, will ensure that the evidence base and understanding of clinical outcomes in pregnant women with SCD is maximised for future research. TRIAL REGISTRATION: NIH registry (www. CLINICALTRIALS: gov), registration number NCT03975894 (registered 05/06/19); ISRCTN (www.isrctn.com), registration number ISRCTN52684446 (retrospectively registered 02/08/19).
Mesh closure of a protruding caesarean scar pregnancy in the 11th week of pregnancy.
Vural M, Rauh M, Hadjiiona A … +2 more , Born T, Köninger A
BMC Pregnancy Childbirth · 2026 Jul · PMID 42399723 · Full text
We report the case of a 30-year-old woman in the first trimester with a cesarean scar pregnancy (CSP) following a previous caesarean section, who wished to preserve the pregnancy. External advice had previously recommend...
We report the case of a 30-year-old woman in the first trimester with a cesarean scar pregnancy (CSP) following a previous caesarean section, who wished to preserve the pregnancy. External advice had previously recommended termination, but an individualized, experimental approach was agreed upon. At 11th weeks' gestation, a mesh was placed over the scar dehiscence and secured in position. The uterus was strongly retroflexed, and the placenta prolapsed through the scar. Direct closure of the cranial and caudal myometrium surrounding the protruding placenta was not feasible; the defect measured approximately 4 cm, and the prolapsed placenta was the size of a mandarin. The patient was closely monitored until 32 weeks' gestation, when she presented with lower abdominal pain and mild vaginal bleeding. A hysterectomy was performed at the patient's request, although a focal resection had been offered. This case demonstrates that live birth can be achieved in extreme CSP and suggest that mesh coverage of large cesarean scar defects may represent a novel, pregnancy-preserving therapeutic option.
Effects of perinatal depression on early breastfeeding: the role of childbirth experience.
Liao P, Shan L, Zhang H … +2 more , Xue J, Zhang L
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393596 · Full text
BACKGROUND: Perinatal depression is a common mood disorder that can negatively affect maternal health and early mother-infant interactions, including breastfeeding practices. Although depression has been linked to lower...
BACKGROUND: Perinatal depression is a common mood disorder that can negatively affect maternal health and early mother-infant interactions, including breastfeeding practices. Although depression has been linked to lower breastfeeding initiation and duration, the mechanisms underlying this relationship remain poorly understood. Childbirth experience-a subjective psychological response to labor and delivery-may play a key mediating role, yet limited research has examined this pathway in the early postpartum period. This study aimed to understand the mediating effect of childbirth experience on the correlation between perinatal depression and early breastfeeding behavior. METHODS: One hundred and one puerpera with natural childbirth were enrolled at the Lianyungang Maternity and Child Health Hospital during September and October 2022 through convenient sampling. Questionnaires were completed within three days postpartum. We investigated the demographic characteristics and early breastfeeding behaviors and measured the childbirth experience and perinatal depression levels using the Childbirth Experience Questionnaire (CEQ 2.0) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Pearson correlation analysis and T-tests were used to explore their early-stage correlation, and the mediating effect of the childbirth experience was analyzed using Bootstrap. RESULTS: Childbirth experience had a negative correlation with perinatal depression (r = -0.217, P < 0.05). T-test results indicated a significant relationship between early breastfeeding behavior, perinatal depression level, and childbirth experience (P < 0.05). Mediation analysis revealed that childbirth experience accounted for 39.9% of the total effect of perinatal depression on early breastfeeding behavior, indicating partial mediation. However, perinatal depression remained directly and significantly associated with early breastfeeding behavior after accounting for the mediator (P < 0.05). CONCLUSIONS: Childbirth experience partially mediates the relationship between perinatal depression and early breastfeeding behavior. These findings suggest an association rather than a causal relationship, and highlight the importance of addressing both psychological well-being and childbirth experiences in clinical settings to promote breastfeeding.
Association of albumin-based inflammatory indices with adverse neonatal outcomes in intrahepatic cholestasis of pregnancy: a retrospective comparative study.
Cicek S, Kapudere B, Kaya Parspancı YB … +5 more , Tavukcuoglu Z, Soyupak B, Eyiceoglu MA, Kutay Yılmaz F, Ayaz R
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393595 · Full text
OBJECTIVE: To evaluate whether albumin-based inflammatory indices are associated with perinatal and neonatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: This retrospective...
OBJECTIVE: To evaluate whether albumin-based inflammatory indices are associated with perinatal and neonatal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: This retrospective comparative study included 277 pregnant women who delivered at a tertiary referral center between January 2020 and December 2025 (ICP, n = 90; controls, n = 187). Albumin-based inflammatory indices were calculated from routine laboratory parameters obtained during the week of delivery. Perinatal and neonatal outcomes were compared between groups. Within the ICP group, associations between inflammatory indices and adverse outcomes were evaluated, and multivariable logistic regression analysis was performed to identify independent predictors within the ICP group of neonatal intensive care unit (NICU) admission. RESULTS: Gestational age at delivery and neonatal birth weight were significantly lower in the ICP group, while rates of preterm birth, low birth weight, and NICU admission were significantly higher compared with controls. Albumin-based inflammatory indices did not differ significantly between groups. Within the ICP group, low birth weight (< 2500 g) was associated with higher NAR (p = 0.031), whereas LAR (p = 0.094) and MAR (p = 0.129) were not statistically significant. NICU admission was associated with higher leukocyte-to-albumin ratio (LAR) (p = 0.036), neutrophil-to-albumin ratio (NAR) (p = 0.032), and monocyte-to-albumin ratio (MAR) (p = 0.017) in univariable analyses. In multivariable logistic regression analysis, higher LAR (OR 1.818, 95% CI 1.026-3.223; p = 0.041) and preterm birth < 37 weeks (OR 6.119, 95% CI 2.145-17.457; p = 0.001) remained independently associated with NICU admission. Exploratory ROC analysis performed within the ICP group demonstrated limited discriminatory performance for all evaluated indices, with modest accuracy observed for LAR (AUC = 0.67) and MAR (AUC = 0.65), whereas other indices, including NPAR (p = 0.455) and CAR (p = 0.065), showed poor and non-significant discriminatory performance. CONCLUSION: Albumin-based inflammatory indices demonstrated limited overall clinical utility in pregnancies complicated by ICP. Among these indices, leukocyte-to-albumin ratio was associated with NICU admission, suggesting a possible association between leukocyte-related inflammatory burden and neonatal outcomes. However, this finding should be interpreted with caution given the limited discriminatory performance of the evaluated indices and the potential for residual confounding. Further prospective studies are needed to validate this observation.
The impact of labor induction in vaginal delivery on the development of mother-to-infant bonding and the mediating role of breastfeeding practices: the Japan Environment and Children's Study.
Hiraoka D, Tachi A, Takahashi Y … +7 more , Kato S, Ito Y, Ohya Y, Saitoh S, Sugiura-Ogasawara M, Kamijima M, Japan Environment & Children’s Study (JECS) Group
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393593 · Full text
PURPOSE: Labor induction using medications such as synthetic oxytocin (synOT) and prostaglandins (PG) has become increasingly common; however, its implications for mother-to-infant bonding remain unclear. These agents ma...
PURPOSE: Labor induction using medications such as synthetic oxytocin (synOT) and prostaglandins (PG) has become increasingly common; however, its implications for mother-to-infant bonding remain unclear. These agents may plausibly influence early bonding by altering peripartum oxytocin-related physiology and by affecting early breastfeeding establishment. We examined whether labor induction and specific induction agents are associated with postpartum mother-to-infant bonding trajectories and evaluated breastfeeding mode as a potential mediator. METHODS: We analyzed data from the Japan Environment and Children's Study (JECS). Among 104,059 fetal records, we included 58,384 mother-infant dyads with complete bonding data at 1, 6, and 12 months postpartum (56.1%; complete-case analysis), restricted to liveborn, term, singleton vaginal deliveries. Mother-to-infant bonding was assessed as mothers' self-reported bonding-related feelings using the Mother-to-Infant Bonding Scale (MIBS). Induction status and induction agents (synOT, PG) were obtained from transcribed medical records. Linear mixed-effects models tested associations with bonding trajectories, and mediation analyses evaluated whether 1-month feeding mode (exclusive formula vs. any breastfeeding) accounted for observed associations. RESULTS: Induction was associated with a time-varying pattern in mother-to-infant bonding (time × induction: β = -0.057, 95% CI [-0.067, -0.046], p < 0.001), although contrasts at 1, 6, and 12 months were not significant (β = 0.013, p = 0.109; β = 0.005, p = 0.482; β = 0.000, p = 0.953). SynOT was associated with poorer bonding at 1 and 6 months (β = 0.027, p = 0.004; β = 0.016, p = 0.024), but not at 12 months (β = 0.010, p = 0.205). Mediation via feeding was small for induction (indirect effect = 0.001, 95% CI [0.0002, 0.001]) and not supported for synOT (indirect effect = 0.0004, 95% CI [-0.00009, 0.001]). CONCLUSION: Labor induction and synOT exposure were associated with poorer early postpartum mother-to-infant bonding, with differences attenuating over the first postpartum year. Exclusive formula feeding was associated with poorer bonding and may contribute to early postpartum differences, supporting the clinical value of proactive breastfeeding support and attention to maternal wellbeing while reassuring families that early challenges often ease over time.
Knowledge, attitude, and practice of birth attendants regarding partograph use and its association with birth outcomes: a cross sectional study in Iran.
Rastegari L, Javadifar N, Shahbazian N … +2 more , Bagheri A, Ghanbari S
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393585 · Full text
BACKGROUND: The partograph is a World Health Organization (WHO)-recommended tool for monitoring labor and supporting timely clinical decisions. Despite its importance, its use remains suboptimal in many low- and middle-i...
BACKGROUND: The partograph is a World Health Organization (WHO)-recommended tool for monitoring labor and supporting timely clinical decisions. Despite its importance, its use remains suboptimal in many low- and middle-income settings, with persistent gaps between knowledge and practice. Evidence from Iran across different categories of birth attendants is limited. This study therefore assessed partograph use among midwives, obstetrics residents, and midwifery students, and its association with selected maternal and neonatal outcomes in teaching hospitals in Ahvaz, southwest Iran. METHODS: This cross-sectional study was conducted in 2023 in four teaching hospitals in Ahvaz, southwest Iran. A total of 155 birth attendants completed self-administered knowledge and attitude questionnaires. The practice of the birth attendants during 371 deliveries was evaluated through direct observation by a researcher, using a standardized observational checklist with predefined criteria. Data were analyzed using SPSS version 20, and chi-square and one-way analysis of Variance (ANOVA) tests were applied, with statistical significance set at P ≤ 0.05. RESULTS: The mean knowledge score of the participants was 15.04, and there was no significant statistical difference between the three groups birth attendants in this regard (P = 0.230). The mean attitude score was 69.00. 66% of the participants had a positive attitude towards the partograph, and a significant statistical difference was observed between birth attendants (P = 0.001). Also, 57.2% of the partograph forms were not completed during labor, 39.6% were incomplete, and only 3.2% of the forms were completed fully and standardly. The chi-square test showed that there was a significant statistical relationship between the type of birth attendance and the completion of the partograph (p = 0.001). The duration of the first stage of labor, the 1st-minute Apgar score, postpartum hemorrhage, the need for resuscitation, and the need for Neonatal Intensive Care Unit (NICU) admission were significantly associated with the completion of the partograph (P < 0.05). CONCLUSIONS: According to the results of this study, despite the acceptable knowledge and attitude scores of obstetric caregivers, the level of partograph use was still very low. Alongside continuous training, appropriate policy-making and structured implementation protocols are essential to ensure optimal partograph use and improve maternal and neonatal outcomes.
Prevalence, characteristics, and outcomes of postpartum hemorrhage in a tertiary hospital in Tigray, Northern Ethiopia (2017-2021): retrospective descriptive study.
Legesse AY, Teka H, Ebrahim MM … +8 more , Berhe E, Yahya M, Gebru MA, Gebru F, Abera BT, Gebre D, Kidanemariam R, Abraha HE
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393574 · Full text
BACKGROUND: Postpartum hemorrhage (PPH) is the major cause of maternal mortality and morbidity worldwide. Its burden is specifically significant in resource-limited settings. OBJECTIVE: The study aimed to assess the prev...
BACKGROUND: Postpartum hemorrhage (PPH) is the major cause of maternal mortality and morbidity worldwide. Its burden is specifically significant in resource-limited settings. OBJECTIVE: The study aimed to assess the prevalence, characteristics, and outcomes of PPH in a tertiary hospital in Tigray, northern Ethiopia, between January 1, 2017, and December 31, 2021. METHODS: This was a cross-sectional study. Data on prevalence, sociodemographic, obstetrics, clinical characteristics, management, and outcome of cases diagnosed with PPH were analyzed using descriptive statistics. RESULTS: During the 5-year study period, 23,090 deliveries were recorded at Ayder Comprehensive Specialized Hospital (ACSH). A total of 269 cases of PPH were treated, providing a prevalence of 1.17% with 95%CI 0.027-1.30 (11 per 1000 deliveries). Twelve incomplete charts were excluded. Primary PPH accounted for 220 (85.6%) of the known cases. Most PPH (53.7%) were diagnosed within 2 h after delivery. The estimated documented mean blood loss was 1,572.9 ml (SD = 914.3). The mean hemoglobin level before PPH and after PPH was 12.2 mg/dl and 7.8 mg/dl, respectively. Regarding management, non-pneumatic anti-shock garment (NASG) was used in 79(30.7%) cases, misoprostol in 144 (56%) cases, oxytocin in 125 (48.6%), and ergometrine in 15 (5.1%) cases. Laparotomy was performed in 59 (23%) cases, and hysterectomy was conducted in 40 (67.8%) of these cases. Organ dysfunction (renal failure) was recorded in 34 (13.2%) cases, 14 (5.4%) developed coagulation dysfunction, and 17 (6.6%) deaths. Seven (3.1%) cases were admitted to the intensive care unit (ICU). CONCLUSIONS AND RECOMMENDATIONS: The results of this study emphasized that PPH still poses a significant challenge for obstetric care in Tigray, Ethiopia. Considering the high case fatality rate, high prevalence of primary PPH, and atony, the practice of active management of the third stage of labor must be assessed, and corrective measures must be taken to institute proper protocols and practice.
Protocol for the ECLIPSE-BRAZIL: a prospective cohort study on biomarkers and risk stratification for Preeclampsia.
Tavares ALT, Pasa VD, de Jesus Fernandes Martins Lima JF … +18 more , Pereira JZ, Maia MQ, Diniz GP, da Silva AJ, de Oliveira FR, Do Carmo KCA, Léo PA, Queiroz SAC, Do Rio SMP, Barros-Pinheiro M, Rios DRA, Do Nascimento Melo LC, Sandrim VC, Matheus MB, Perucci LO, Dusse LMS, Godoi LC, Alpoim PN
BMC Pregnancy Childbirth · 2026 Jul · PMID 42393560 · Full text
BACKGROUND: Preeclampsia (PE) is a leading cause of maternal and perinatal morbimortality, particularly in low- and middle-income countries. Despite advances in clinical management, its etiology and pathogenesis remain u...
BACKGROUND: Preeclampsia (PE) is a leading cause of maternal and perinatal morbimortality, particularly in low- and middle-income countries. Despite advances in clinical management, its etiology and pathogenesis remain unclear, and effective predictive biomarkers are lacking. The Brazilian Longitudinal Study for the Investigation of Preeclampsia (ECLIPSE-BRAZIL) is a prospective cohort designed to investigate genetic, immunological, hemostatic, biochemical, and angiogenic profiles in pregnant women at risk for PE, aiming to identify biomarkers that effectively and affordably predict PE risk early in pregnancy. METHODS: ECLIPSE-BRAZIL follows 500 to 1,000 pregnant women receiving care at the High-Risk Prenatal Care clinics in Belo Horizonte and Divinópolis, Minas Gerais, Brazil. Clinical and laboratory assessments are conducted at four gestational stages and postpartum for PE cases. Clinical data, including sociodemographic, clinical and behavioral factors, and blood and urine samples are systematically collected. Plasma and urine levels of inflammatory markers, angiogenic factors, oxidative stress parameters, extracellular vesicles, microRNAs, endothelial and platelet markers will be analyzed. Participants are stratified by PE development and gestational age at diagnosis. Standardized criteria and data protocols ensure rigor, while quality check and audits enhance data reliability. To minimize follow-up loss, participants are contacted frequently, with flexible sampling and the use of hospital records. DISCUSSION: ECLIPSE-BRAZIL will provide novel insights into PE pathophysiology, improving disease prediction and management. By studying a diverse population, we will identify biological signatures to inform health innovations: development of cost-effective diagnostic tools, point-of-care tests and simple clinical algorithms to identify women at risk before symptoms become severe. Finally, we will provide a deeper understanding of biological mechanisms driving PE and its subtypes, including endothelial function and immune response, which may lead to the discovery of new therapeutic targets. ECLIPSE-BRAZIL represents a major advancement in PE research, integrating a comprehensive evaluation of clinical, biochemical, and molecular markers throughout pregnancy. Its findings may inform public health policies and improve clinical practices worldwide. TRIAL REGISTRATION: Not applicable. This is an observational cohort study approved by the Research Ethics Committees, as documented under the following CAAE numbers: 12471918.0.0000.5149, 12471918.0.3002.5119, 12471918.0.3003.5130, 12471918.0.3006.5545.
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