BACKGROUND: The implication of intermediately elevated fasting plasma glucose (FPG) in the first trimester of pregnancy is uncertain.
OBJECTIVE: The primary outcome of the meta-analysis was to analyze if intermediately elevated first-trimester FPG could predict development of GDM at 24-28 weeks. The secondary outcomes were to determine if the commonly used FPG cut-offs 5.1 mmol/L (92 mg/dL), 5.6 mmol/L (100 mg/dL), and 6.1 mmol/L (110 mg/dL) correlated with adverse pregnancy events.
METHODS: Databases were searched for articles published from 2010 onwards for studies examining the relationship between first-trimester FPG and adverse fetomaternal outcomes.
METHODS: A total of sixteen studies involving 115,899 pregnancies satisfied the inclusion criteria.
METHODS: Women who developed GDM had a significantly higher first-trimester FPG than those who did not [MD 0.29 mmoL/l (5 mg/dL); 95 % CI: 0.21-0.38; P < 0.00001]. First-trimester FPG ≥5.1 mmol/L (92 mg/dL) predicted the development of GDM at 24-28 weeks [RR 3.93 (95 % CI: 2.67-5.77); P < 0.0000], pre-eclampsia [RR 1.55 (95%CI:1.14-2.12); P = 0.006], gestational hypertension [RR1.47 (95%CI:1.20-1.79); P = 0.0001], large-for-gestational-age (LGA) [RR 1.32 (95%CI:1.13-1.54); P = 0.0004], and macrosomia [RR1.29 (95%CI:1.15-1.44); P < 0.001]. However, at the above threshold, the rates of preterm delivery, lower-segment cesarean section (LSCS), small-for gestational age (SGA), and neonatal hypoglycemia were not significantly higher. First-trimester FPG ≥5.6 mmol/L (100 mg/dL) correlated with occurrence of macrosomia [RR1.47 (95 % CI:1.22-1.79); P < 0.0001], LGA [RR 1.43 (95%CI:1.24-1.65); P < 0.00001], and preterm delivery [RR1.51 (95%CI:1.15-1.98); P = 0.003], but not SGA and LSCS.
CONCLUSIONS: Only one study reported outcomes at first-trimester FPG of 6.1 mmol/L (110 mg/dL), and hence was not analyzed.
CONCLUSIONS: The risk of development of GDM at 24-28 weeks increased linearly with higher first-trimester FPG. First trimester FPG cut-offs of 5.1 mmol/L (92 mg/dL) and 5.6 mmol/L (100 mg/dL) predicted several adverse pregnancy outcomes.

The birth and delivery plan is the center of clinical communication between the pregnant woman and the midwife, which is in the scope of health care services and is designed and provided to specialists with the participation of the woman and her husband during pregnancy. This document reflects the preferences, expectations, and fears of pregnant women regarding the birth process. This study was conducted with the aim of determining the maternal and neonatal outcomes of the birth plan: a review study. In this review study, Persian databases Magiran, SID, and English databases Pubmed, Scopus, SID Elsevier, Web of Sciences, and Google Scholar search engine using English keywords including Maternal outcome, neonatal outcome, birth schedule, delivery plan, birth plan, and their Persian equivalents were searched from 2000 to 2022. Numerous studies were selected and analyzed in a quantitative and qualitative manner that was related to the purpose of the present study in terms of content. Among 948 articles, 13 of the most relevant ones were selected and analyzed for this study. The results of the review of the studies showed that the birth plan has an effect on women\'s empowerment, satisfaction with childbirth, positive experience of childbirth, cesarean section rate, epidural use rate, episiotomy rate, Apgar, and umbilical cord pH of the newborn. The maternal and neonatal consequences of the birth plan prevail over its negative consequences, and the use of the birth plan can increase women\'s empowerment, satisfaction with childbirth, positive experience of childbirth, and reduce the rate of cesarean section and negative maternal-neonatal consequences.

UNASSIGNED: Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH.
UNASSIGNED: We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched.
UNASSIGNED: The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described.
UNASSIGNED: The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.

Adult granulosa cell tumours (AGCTs) of the ovary are very rare during pregnancy. To date, only five cases of ovarian AGCT in pregnancy have been reported in the literature and the patients all conceived spontaneously. We report a case of AGCT of the ovary that was incidentally discovered during a caesarean section in a patient undergoing In vitro fertilisation (IVF). To the authors\' knowledge, this is the first case of AGCT incidentally discovered during caesarean section in a pregnant patient after IVF. A 44-year-old primigravida with 39 weeks gestation was admitted to our hospital due to premature rupture of membranes in May 2019. She was treated by in vitro fertilisation due to being an elderly mother and she was pregnant after the first cycle. She was indicated for caesarean section due to conceiving following in vitro fertilisation and being an elderly mother. She gave birth to a 3,000 g baby boy and his Apgar scores were 8/1\'-9/5\'. When examining the adnexa, the left ovary had a tumour with a size of 7 × 4 × 4 cm. Left oophorectomy was performed and specimen sent to for histopathology. The histopathological diagnosis was an AGCT of the ovary. A month later, the patient received chemotherapy with Carboplatin and Paclitaxel for four cycles. After 32 months of follow-up, no recurrence was detected. In conclusion, AGCTs of the ovary are very rare during pregnancy. Pre-operative diagnosis is difficult. Conservative surgery should be considered in women who wish to have children. Patients should receive adequate counselling and long-term follow-up to ensure the highest survival rates and early detection of recurrence.

BACKGROUND: Eclampsia, defined as the occurrence of generalised, tonic-clonic convulsions or coma that is unrelated to other medical conditions in a woman with hypertensive disorder of pregnancy, is a leading cause of maternal and perinatal morbidity and mortality.
METHODS: Retrospective review of cases of eclampsia managed over 15 years (2006 to 2020) at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. Factors associated with adverse maternal and perinatal outcomes were determined using appropriate bivariate analysis. Statistical significance was set at P < 0.05.
RESULTS: The prevalence of eclampsia was 2.96%. Most of the patients, 55.2% (420/761) were >35 years, 76% (579/761) were primigravidae and 80.4% (612/761) were unbooked. In 59.1% (450/761) of the cases, the eclampsia was antepartum and 40.3% (301/761) were delivered through a caesarean section. The commonest risk factor was previous eclampsia. There were 58(7.6%) maternal deaths, and the perinatal mortality was 18.1% (138/761). There was a statistically significant association between adverse maternal outcomes and having no formal education (P<0.001), being unemployed (P<0.001), being in coma for >10 hours(P=0.029), caesarean delivery (P<0.001), SBP >160mmHg (P<0.001) and DBP >110mmHg (P<0.001). Adverse perinatal outcome was significantly associated with having no formal education (P<0.001), being unemployed (P=0.004), unbooked status (P=0.015), multiple pregnancy (P=0.021), preterm delivery(P<0.001), caesarean delivery (P=0.012) and Systolic BP >160mmHg (P<0.001).
CONCLUSIONS: The prevalence of eclampsia is high. Having no formal education, unemployment, coma of 10 hours or more, vaginal delivery and severe hypertension, unbooked status, and multiple gestation are significantly associated with poor maternal or fetal outcomes.
BACKGROUND: L’éclampsie, définie comme la survenue de convulsions tonico-cloniques généralisées ou d’un coma sans rapport avec d’autres conditions médicales chez une femme atteinte d’un trouble hypertensif de la grossesse, est une cause majeure de morbidité et de mortalité maternelles et périnatales.
METHODS: Examen rétrospectif des cas d’éclampsie pris en charge sur 15 ans (2006 à 2020) à l’hôpital universitaire de Maiduguri, État de Borno, Nigéria. Les facteurs associés aux issues maternelles et périnatales indésirables ont été déterminés à l’aide d’une analyse bivariée appropriée. La signification statistique a été fixée à P < 0,05.
RESULTS: La prévalence de l’éclampsie était de 2,96 %. La plupart des patients, 55,2 % (420/761) >35 ans, 76 % (579/761) étaient Primigravidés et 80,4 % (612/761) non réservés. Dans 59,1 % (450/761) des cas, l’éclampsie était antepartum et 40,3 % (301/761) ont été accouchés par césarienne. Le facteur de risque le plus courant était une éclampsie antérieure. Il y avait 58 (7,6%) décès maternels et la mortalité périnatale était de 18,1% (138/761). Il y avait une association statistiquement significative entre les issues maternelles défavorables et l’absence d’éducation formelle (P<0,001), le chômage (P<0,001), le coma pendant >10 heures (P=0,029), l’accouchement par césarienne (P<0,001), PAS > 160 mmHg (P<0,001) et PAD ed110 mmHg (P<0, 001). Les résul t at s péri nataux i ndési rabl es ét ai ent significativement associés à l’absence d’éducation formelle (P<0,001), au chômage (P=0,004), au statut non réservé (P=0,015), à la grossesse multiple (P=0,021), à l’accouchement prématuré (P<0,001), à la césarienne accouchement (P=0,012) et TA systolique >160mmHg (P<0,001).
CONCLUSIONS: La prévalence de l’éclampsie est élevée. L’absence d’éducation formelle, le chômage, le coma de 10 heures ou plus, l’accouchement vaginal et l’hypertension sévère, le statut non réservé et la grossesse multiple sont significativement associés à de mauvais résultats maternels ou fœtaux.
UNASSIGNED: Eclampsie, Issue maternelle, Issue périnatale, Prévalence, Facteurs de risque.

The aim of this study is to review the currently available data, and to explore the association of infection with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants during pregnancy with maternal and perinatal outcomes in the real world. Observational cohort studies were analyzed that described the maternal and perinatal outcomes of infection with different SARS-CoV-2 variants during pregnancy. Random-effects inverse-variance models were used to evaluate the pooled prevalence (PP) and its 95% confidence interval (CI) for maternal and perinatal outcomes. Random effects were used to estimate the pooled odds ratios (OR) and their 95% CI for different outcomes between Delta and pre-Delta periods, and between Omicron and Delta periods. Eighteen studies, involving a total of 133,058 cases of SARS-CoV-2 infection during pregnancy (99,567 cases of SARS-CoV-2 wild type or pre-variant infection and 33,494 cases of SARS-CoV-2 variant infections), were included in this meta-analysis. Among pregnant women with SARS-CoV-2 infections, the PPs for required respiratory support, severe or critical illness, intensive care unit (ICU) admission, maternal death, and preterm birth <37 weeks were, respectively, 27.24% (95%CI, 20.51−33.97%), 24.96% (95%CI, 15.96−33.96%), 11.31% (95%CI, 4.00−18.61%), 4.20% (95%CI, 1.43−6.97%), and 33.85% (95%CI, 21.54−46.17%) in the Delta period, which were higher than those in the pre-Delta period, while the corresponding PPs were, respectively, 10.74% (95%CI, 6.05−15.46%), 11.99% (95%CI, 6.23−17.74%), 4.17% (95%CI, 1.53−6.80%), 0.63% (95%CI, 0.05−1.20%), and 18.58% (95%CI, 9.52−27.65%). The PPs for required respiratory support, severe or critical illness, and ICU admission were, respectively, 2.63% (95%CI, 0.98−4.28%), 1.11% (95%CI, 0.29−1.94%), and 1.83% (95%CI, 0.85−2.81%) in the Omicron period, which were lower than those in the pre-Delta and Delta periods. These results suggest that Omicron infections are associated with less severe maternal and neonatal adverse outcomes, though maternal ICU admission, the need for respiratory support, and preterm birth did also occur with Omicron infections. Since Omicron is currently the predominant strain globally, and has the highest rates of transmission, it is still important to remain vigilant in protecting the vulnerable populations of mothers and infants. In particular, obstetricians and gynecologists should not ignore the adverse risks of maternal ICU admission, respiratory support, and preterm births in pregnant patients with SARS-CoV-2 infections, in order to protect the health of mothers and infants.

Cardiac interventions during advanced gestation carry a risk of maternal complications including mortality, along with the serious threat to the life of a viable fetus. However, with advancements in anesthesia and surgery techniques, cardiac interventions can be performed successfully during the peripartum period. We report two cases of decompensated severe valvular stenosis in the third trimester. One patient underwent balloon valvuloplasty followed by cesarean delivery. However, the other underwent a cesarean delivery followed by double valve replacement. Favorable maternal and fetal outcomes were achieved through peripartum interventions. Good fetomaternal outcomes can be obtained in women with severe valvular heart disease (VHD) presenting late in pregnancy. The decision for the timing of cardiac intervention in relation to cesarean section (CS) can vary from case-to-case basis.

The use of frozen embryo transfer in assisted reproductive technology (ART) has steadily increased since development in the early 1980\'s. While there are many benefits to delayed frozen embryo transfer, certain adverse perinatal outcomes are noted to be more common in these transfers when compared to fresh transfers, specifically hypertensive disorders of pregnancy. Frozen embryo transfers require coordination between the embryo\'s developmental stage and the endometrial environment and can occur in either ovulatory or programmed cycles. Though there is no consensus on the ideal method of endometrial preparation prior to frozen embryo transfer, emerging data suggests differences in maternal and neonatal outcomes, specifically increased rates of hypertensive disorders of pregnancy in programmed cycles. Other reported differences include an increased risk of cesarean delivery, placenta accreta, postpartum hemorrhage, low birthweight, preterm birth, post term delivery, macrosomia, large for gestational age, and premature rupture of membranes in programmed cycles. The mechanism by which these differences exist could reflect inherent differences in groups selected for each type of endometrial preparation, the role of super physiologic hormone environments in programmed cycles, or the unique contributions of the corpus luteum in ovulatory cycles that are not present in programmed cycles. Given that existing studies are largely retrospective and have several key limitations, further investigation is needed. Confirmation of these findings has implications for current practice patterns and could enhance understanding of the mechanisms behind important adverse perinatal outcomes in those pursuing assisted reproduction.

Granulosa cell tumors are rare ovarian tumors that can arise during pregnancy. We present a new case of recurrent adult granulosa cell tumor (AGCT) in pregnancy and a systematic review of the literature. The new case described is a 41-year-old woman G5P1122 with a prior history of AGCT that was referred to our center at 29 weeks because of a symptomatic abdominal mass, compatible with a possible recurrence of AGCT. At 36 + 3 weeks, she underwent a cesarean delivery for preterm labor and a total hysterectomy with a radical surgical staging. A healthy female infant was delivered. The patient received a platinum-based chemotherapy, with a 26-month follow-up negative for recurrence. Analyzing our case with the four identified by the literature review, three were recurrent and two were primary AGCT. Only one required surgery for AGCT at 15 weeks, while another underwent chemotherapy in pregnancy. In the other three cases, surgery for AGCT was done at the time of cesarean delivery. There were three cases of preterm delivery. All five pregnancies resulted in the birth of live babies with weight adequate for gestational age. In conclusion, AGCT diagnosed in pregnancy is rare, reported in only five cases. All gave birth to live babies in the third trimester, and maternal outcome at up to 18 months showed no recurrence.

This study aimed to summarize the evidence regarding the effects of dietary intake before conception on pregnancy outcomes by performing a systematic review and meta-analysis of prospective studies. Electronic databases were searched from inception up to August 2021. Overall, 65 studies involving 831 798 participants were included and 38 studies were quantitatively pooled. With regard to maternal outcomes, pre-pregnancy intake of fried food, fast food, red and processed meat, heme iron and a low-carbohydrate dietary pattern was positively associated with the risk of gestational diabetes mellitus (GDM) (all P < 0.05). However, a high dietary fiber intake and folic acid supplementation were negatively associated with GDM risk (both P < 0.05). With regard to neonatal outcomes, maternal caffeine intake before pregnancy significantly increased the risk of spontaneous abortion, while folic acid supplementation had protective effects on total adverse neonatal outcomes, preterm birth, and small-for-gestational age (SGA, all P < 0.05). However, no significant associations were found between adverse pregnancy outcomes (i.e., GDM and SGA) and the pre-pregnancy dietary intake of sugar-sweetened beverages, potato, fish, and carbohydrates and the Healthy Eating Index. Our study suggests that maintaining a healthy diet before conception has significant beneficial effects on pregnancy outcomes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1989658.