Diagnosis and management of group B streptococcus in pregnancy.

Group B streptococcus (GBS) can cause significant maternal and neonatal morbidity. Over the past 30 years, reductions in early-onset GBS neonatal sepsis in the United States have been attributable to the guidelines from the Centers for Disease Control and Prevention for antepartum screening and treating this organism during labor. This article highlights the clinical implications, screening, diagnosis, prophylactic interventions, and future therapies for mothers with GBS during the peripartum period

Recognizing who is at risk for postpartum hemorrhage: Targeting Anemic Women and Scoring Systems for Clinical Use

Iron deficiency anemia during pregnancy is a common concern, affecting 38% of women worldwide, and up to 50% in developing countries. It is defined differently throughout all three trimesters. It has several detrimental effects on pregnancy outcomes for both the mother and the fetus such as increasing the risk of postpartum depression, preterm delivery, cesarean delivery, preeclampsia and low birth weight. Management of iron deficiency anemia is done classically via oral iron supplementation. However, recent evidence has shown intravenous iron as a good alternative to oral iron if patients are unable to tolerate, not responding or present very late in pregnancy with new diagnosis. Management of iron deficiency anemia was demonstrated to be a protective against postpartum hemorrhage. Other ways to prevent postpartum hemorrhage include improving prediction tools that recognize who is at risk. Several risk assessment kits have been developed to estimate the risk of postpartum hemorrhage in patients and were proven to be useful in predicting patients at high risk of postpartum hemorrhage, despite limitations in low-risk groups. More comprehensive tools are also being explored, by determining clinically relevant factors through nomograms, with some proving their efficacy after implementation. Machine learning is also being utilized to form more complete tools, by including risk factors previously not accounted for. These newer tools however still require external validation before being adopted, despite promising results in testing conditions

GBS screening: An update on guidelines and methods

Great advances have been made in preventing neonatal GBS sepsis of both early and late onset. despite recommendations, however, screening is not universal or uniform

Impact of anemia and thrombocytopenia on postpartum hemorrhage risk among women with term singleton pregnancy

Both thrombocytopenia (platelet count \u3c 150 × 10/µL) and anemia have been associated with postpartum hemorrhage (PPH). However, the impact of thrombocytopenia on PPH risk among women with mild and severe anemia is unknown. We sought to evaluate the association between thrombocytopenia and anemia in increasing risk of PPH. We performed a secondary analysis of a retrospective cohort of pregnant women from 19 hospitals across the United States from 2016 to 2021. Women who had a term singleton pregnancy and hematocrit (Hct) ≤ 33% at delivery were included in the study. The primary outcome was PPH (defined as blood loss ≥ 1000 mL or blood transfusion). We also analyzed the effect of severe anemia (Hct \u3c 28%) on the association between PPH and thrombocytopenia. Chi-squared tests and Fisher\u27s exact tests were used for categorical variables and an independent t-test was used for continuous variables. There were 20,808 women who met our inclusion criteria, of which 1793 (8.6%) had platelet count \u3c 150 × 10/µL. The prevalence of PPH was 6.4%. Compared with women with normal platelet count, those with thrombocytopenia had 1.3-fold higher odds of PPH [6.8% vs. 4.5%, adjusted OR 1.3 (1.1-1.7)]. Platelet count ≥ 150 × 10/µL was associated with decreased odds of PPH among patients with hct between 28 and 33% and hct \u3c 28%. In conclusion, anemic women with term singleton pregnancies who delivered with thrombocytopenia had a higher frequency of PPH. Normal platelet count at delivery was protective against PPH in the setting of anemia regardless of severity

Disparities in obstetric hemorrhage outcomes

Both the maternal and fetal outcomes of pregnancy vary greatly according to a pregnant woman\u27s community and her condition. The most devastating outcome is the death of a mother. In 2017, there were ≈295,000 maternal deaths globally with dramatic differences in maternal mortality based on geographic region, country, and women\u27s underlying conditions. Worldwide, the leading cause of maternal death is hemorrhage, comprising 94% of maternal deaths, with most cases occurring in low- or middle-income countries. Whether a hemorrhage originates from inside the uterus (80%-90%), from lacerations or incisions (10%-20%), or from an underlying coagulopathy (\u3c1%), an acute acquired coagulopathy will evolve unless the hemorrhage is controlled. In low- or middle-income countries, the full range of resources to control hemorrhage is not available, but besides the usual obstetric measures, blood availability, hemostatic medication, and hematologic expertise are necessary to save mothers\u27 lives. Hemostasis and thrombosis experts can address the disparities in obstetric hemorrhage outcomes not only as providers but as consultants, researchers, and advocates

Pharmacoethics and pregnancy: Overcoming the therapeutic orphan stigma

There is paucity of evidence to support clinical decision making and counselling related to medication use in pregnancy. Despite multiple efforts from legislative bodies and advocacy groups, the inclusion of pregnant women in clinical drug trials assessing efficacy and safety remains scarce. Pregnancy can be complicated by multiple comorbidities that require pharmacological intervention; these interventions primarily target the pregnant woman but also sometimes have secondary effects for the foetus. The US Food and Drug Administration has issued multiple guidance documents on incorporating pregnant women in clinical trials to aid pharmaceutical companies in designing a protocol to ensure safety and adherence to ethical standards. Advances in paediatric pharmacology studies provide lessons for researchers on the best practice of designing clinical trials with inclusion of patients from special populations. In this review, we present the status of pregnant women in clinical trials, highlighting the ethical stigma and possible future directives