Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.

This article presents the technical aspects of the Polish fetal cardiac interventions (FCI) program, including preparation of the team and modifications in the technique of the procedure that aim to increase its safety for the mother and the fetus. Over 9 years, 128 FCI in 113 fetuses have been performed: 94 balloon aortic valvuloplasties (fBAV), 14 balloon atrioseptoplasties (fBAS) with stent (BAS+), 5 balloon atrioseptoplasties without stent placement (BAS−), and 15 fetal pulmonary valvuloplasties (fBPS). The technical success rate ranged from 80% (BAS−) to 89% (fBAV), while the procedure-related death rate (defined as death within 72 hours following the procedure) ranged from 7% (fBAV and fBPV) to 20% (BAS). There were 98 live births after all FCI (3 pregnancies continue). Median gestational age at delivery was 39 weeks in our center and 38 weeks in other centers.

The aim of fetal cardiac interventions (FCI), as other prenatal therapeutic procedures, is to bring benefit to the fetus. However, the safety of the mother is of utmost importance. The objective of our study was to evaluate the impact of FCI on maternal condition, course of pregnancy, and delivery. 113 mothers underwent intrauterine treatment of their fetuses with critical heart defects. 128 percutaneous ultrasound-guided FCI were performed and analyzed. The patients were divided into four groups according to the type of FCI: balloon aortic valvuloplasty (fBAV), balloon pulmonary valvuloplasty (fBPV), interatrial stent placement (IAS), and balloon atrioseptoplasty (BAS). Various factors: maternal parameters, perioperative data, and pregnancy complications, were analyzed. There was only one major complication—procedure-related placental abruption (without need for blood products transfusion). There were no cases of: procedure-related preterm prelabor rupture of membranes (pPROM), chorioamnionitis, wound infection, and anesthesia associated complications. Tocolysis was only necessary only in two cases, and it was effective in both. None of the patients required intensive care unit admission. The procedure was effective in treating polyhydramnios associated with fetal heart failure in six out of nine cases. Deliveries occurred at term in 89%, 54% were vaginal. The results showed that FCI had a negligible impact on a further course of pregnancy and delivery.

Background: SARS-CoV-2 infection in pregnant women may induce inflammation within the amniotic cavity and/or an increase in proinflammatory cytokines in fetal circulation. The aim was to investigate levels of IL-6 in maternal blood, umbilical cord blood, and amniotic fluid in pregnant women infected with SARS-CoV-2 at delivery. Methods: A single-center prospective observational case–control study of pregnant women diagnosed with SARS-CoV-2 infection at delivery was conducted. A total of 48 infected and 42 healthy women had IL-6 concentrations measured in their blood, amniotic fluid, and umbilical cord blood. Results: The concentrations of IL-6 in maternal blood and amniotic fluid were similar in the study and control groups, while umbilical cord blood concentrations were significantly higher in SARS-CoV-2-positive women. The umbilical cord blood IL-6 concentration was related to composite neonatal morbidity. Conclusions: Maternal SARS-CoV-2 infection in pregnant women at delivery increases umbilical cord blood IL-6 concentration. The correlation between maternal and umbilical blood concentrations indicates a possibility of passage of IL-6 through the placenta. Perinatal alterations resulting from maternal SARS-CoV-2 infection at delivery carry a risk of impacting the health of infants even in asymptomatic course of infection.

Emergency cervical cerclage is used to reduce extreme preterm birth in women with advanced cervical dilatation and exposed fetal membranes. Although double-level cerclage has been proposed to provide greater mechanical support than single-level cerclage, evidence comparing these techniques in emergency settings is limited. To compare the effectiveness of emergency double-level versus single-level cerclage, both combined with adjunctive vaginal progesterone, antibiotics and indomethacin in preventing delivery before 34 weeks of gestation. This prospective, multicenter, open-label randomized controlled trial was conducted at seven tertiary perinatal centers in Poland. Women with singleton pregnancies between 16+0 and 25+6 weeks of gestation, advanced cervical dilatation, and visible fetal membranes were randomized 1:1 to single-level or double-level cerclage. All participants received a standardized management protocol including vaginal progesterone, empirical antibiotics (ceftriaxone, clarithromycin, and metronidazole), perioperative indomethacin, and antenatal corticosteroids when indicated. The primary outcome was delivery before 34 weeks of gestation. Secondary outcomes included gestational age at delivery, latency to delivery, maternal complications, and neonatal outcomes. Time-to-event analyses and Cox regression models were applied. Eighty women underwent emergency cerclage (38 single-level, 42 double-level suture). Delivery before 34 weeks occurred in 27.5% of the overall cohort (23.7% of the single-level group and 31.0% of the double-level cerclage group, p=0.53), which was relatively low rate compared with historical reports in women presenting with advanced cervical dilatation and prolapsed membranes. Gestational age at delivery, latency from cerclage placement to delivery, and rates of delivery before 37, 32, and 28 weeks did not differ significantly between groups. Neonatal outcomes, including survival and major morbidity, were comparable. Procedure-related complications were infrequent. In women with advanced cervical insufficiency and exposed fetal membranes, double-level emergency cerclage combined with adjunctive therapy was not found to improve pregnancy prolongation or perinatal outcomes compared with single-level cerclage.