Amanda M. Craig

Antepartum bleeding is a common complication of placenta previa and contributes to maternal and neonatal morbidity; however, limited data describe bleeding patterns and their clinical course. We sought to identify predictors of antepartum bleeding and to characterize bleeding patterns among patients with placenta previa. Retrospective cohort study of patients with ultrasound-confirmed persistent placenta previa delivering at a tertiary academic center (June 2013-March 2025). The primary outcome was antepartum bleeding, defined as any bleeding episode preceding delivery prompting hospital evaluation. Demographic and clinical characteristics were compared between patients with and without bleeding using bivariate tests and multivariable logistic regression. Among patients who experienced bleeding, secondary analyses evaluated bleeding recurrence, gestational age at first bleeding episode, number of bleeding episodes, and latency from bleeding to delivery. Among 247 patients with placenta previa, 139 (56.3%) experienced antepartum bleeding. Advanced maternal age (50/139 vs. 61/108, p = 0.001) and obesity (36/139 vs. 45/108, p = 0.009) were less common among patients with bleeding. In multivariable analysis, advanced maternal age (odds ratio: 0.42, 95% confidence interval: 0.25-0.71) and obesity (odds ratio: 0.50, 95% confidence interval: 0.28-0.89) were independently associated with decreased odds of antepartum bleeding. Among those with bleeding, recurrent bleeding occurred in 85/139 (61.2%) patients and was associated with an earlier gestational age at first bleed (median 28.0 vs. 31.6 weeks, p < 0.001). Descriptive trends demonstrated shorter latency to delivery and a greater proportion of bleeding episodes prompting delivery as the number of bleeding episodes increased. Antepartum bleeding occurred in more than half of pregnancies complicated by placenta previa and frequently recurred. Bleeding timing and recurrence may have clinical relevance for counseling and anticipatory management, warranting further prospective study. · Antepartum bleeding is a common complication of placenta previa, but limited data describe bleeding patterns, recurrence, and timing in affected pregnancies.. · Antepartum bleeding occurred in 56.3% of patients with placenta previa and recurred in 61.2% of those who experienced bleeding.. · Earlier gestational age at first bleeding episode was associated with recurrent bleeding, and increasing numbers of bleeding episodes were associated with shorter latency to delivery.. · This study characterizes bleeding patterns in placenta previa and suggests that earlier bleeding onset and recurrent episodes may reflect a more severe clinical course..

Thyroid storm is a rare, life-threatening endocrine emergency in pregnancy with significant maternal and neonatal implications. Clinical symptoms may mimic those of hypertensive disorders in pregnancy. Prompt diagnosis and multidisciplinary management are critical for reducing maternal and neonatal morbidity and mortality. A 31-year-old woman with a dichorionic diamniotic twin pregnancy, chronic hypertension, short cervix, and poorly controlled Graves' disease presented at 22 weeks' gestation with vaginal bleeding and severe-range blood pressures. She was diagnosed with thyroid storm and admitted to the intensive care unit. She failed to respond to maximal medical management, ultimately requiring plasmapheresis. She later developed preterm labor and spontaneously delivered periviable twins. She eventually underwent total thyroidectomy for definitive management of thyroid storm. This case illustrates the severe consequences of poorly controlled Graves' disease in pregnancy. Although thyroid storm can mimic preeclampsia, abnormal thyroid function tests, persistent tachycardia, fevers, and hypertension with wide pulse pressures may help distinguish it. Timely recognition and multidisciplinary care are imperative to decrease morbidity and mortality associated with thyroid storm.

Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy- and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT.This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010 and 2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included nontransfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes or preterm prelabor rupture of membranes, cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size, and teaching status, were also used to produce adjusted relationships between HHT status and outcomes.The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in the HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p < 0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared with patients without HHT (7.8 vs. 1.7%, adjusted relative risk [aRR]: 4.49 [95% confidence interval, CI: 3.06, 6.58]). Rates of preterm birth (14.2 vs. 8.5%, aRR: 1.57 [95% CI: 1.22, 2.03]), cesarean delivery (41.0 vs. 32.9%, aRR: 1.23 [95% CI: 1.07, 1.41]), respiratory bleeding (2.1 vs. <0.1%, aRR: 94.44 [56.64, 157.46]), and cerebrovascular complications (0.9 vs. <0.1%, aRR: 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups.Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared with the baseline population.

Objective The COVID pandemic has been associated with varied effects on preterm birth (PTB). We sought to compare rates of PTB during the pre- and post vaccination COVID periods with pre-pandemic PTB rates, stratified by race and ethnicity. Study Design Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary center during “early” (March 2020–June 2020) versus “late” COVID (March 2021–June 2021), and “late” COVID versus pre-COVID (March to June 2014–2019). PTBs <37, <34, and <28 weeks were compared and stratified by race/ethnicity. Results A total of 16,483 deliveries occurred including 2,068 “early” COVID, 2,115 “late” COVID, and 12,300 pre-COVID. The PTB rate during “late” COVID was lower compared to “early” COVID (12.1 vs. 14.6%, p = 0.02). Rate of PTB <34 was also lower during “late” COVID (4.4 vs. 5.7%, p = 0.05). PTB <28 did not differ. When controlling for prior PTB, “late” COVID remained associated with a decreased risk of PTB compared to “early” COVID, adjusted odds ratio (aOR) of 0.82 (95% confidence interval [CI]: 0.68, 0.98). Although there was no difference in PTB among Hispanic individuals when comparing “late” COVID versus pre-COVID, when further subdivided, a small number of Hispanic Puerto Rican individuals had higher odds of PTB < 37 during “late” COVID versus pre-COVID (aOR = 4.29 [95% CI: 1.12, 16.4]). Additionally, White individuals had reduced odds of PTB <37 (aOR = 0.80 [95% CI: 0.65, 0.98]) during “late” COVID versus pre-COVID while the PTB rate was unchanged when comparing “late” COVID versus pre-COVID in all other racial and ethnic groups. Conclusion During 2021, PTB rates decreased from rates observed in 2020 at the height of COVID restrictions. Among White birthing individuals, PTB decreased in 2021 compared to pre-COVID rates. This decrease was not observed in Black and Hispanic birthing individuals. These data highlight the continued racially disparate impact of the COVID-19 pandemic on PTB rates. Key Points

We sought to evaluate and describe the maternal and obstetric morbidity associated with Listeria infection in pregnancy.Retrospective cohort of pregnant women using the 2007-2018 National Inpatient...

Objective We sought to investigate the positive predictive value of ultrasound-diagnosed fetal growth restriction (FGR) for estimating small for gestational age (SGA) at birth. Secondary objectives were to describe clinical interventions performed as a result of FGR diagnosis.Study Design This was a retrospective cohort of pregnancies diagnosed with FGR over 3 years at a single institution. Maternal demographics, antenatal and delivery data, and neonatal data were collected. Descriptive statistics and linear regression were conducted.Results We included 406 pregnancies with diagnosis of FGR in second or third trimester. Median birth weight percentile was 17 (interquartile range: 5–50) and only 35.0% of these fetuses were SGA at birth. The positive predictive value of a final growth ultrasound below the 10th percentile for SGA at birth was 56.9%. Patients averaged eight additional growth ultrasounds following FGR diagnosis. One hundred and fourteen (28.1%) received antenatal steroids prior to delivery, and 100% of those delivered after more than 7 days following administration. There were 6 fetal deaths and 14 neonatal deaths.Conclusion In the majority of cases, pregnancies diagnosed with FGR during screening ultrasounds resulted in normally grown neonates and term deliveries. These patients may be receiving unnecessary ultrasounds and premature courses of corticosteroids.