Objective: To evaluate the relationship of fetal sex with obstetric risk factors and perinatal outcomes. Material and methods: Retrospective study of deliveries during 2003–2009 at a tertiary hospital based on the analysis of obstetric and neonatal risk variables according to neonatal sex. Results: Of the 29,530 deliveries studied, the neonate was a boy in 15,038 (50.92%) and a girl in 14,492 (49.08%). The rates of gestational diabetes, prematurity, true umbilical cord knot and nuchal cord were higher for male newborns, whereas the rate of echographic diagnosis of intrauterine fetal growth retardation was higher for female newborns. Mothers of male fetuses had higher rates of cesarean delivery and instrumental vaginal delivery. The indication for ending labor due to the non-reassuring fetal heart rate was also more frequent among male newborns. This group had higher rates of acidemia, although there were no significant differences between sexes in other short-term neonatal outcomes. In all subgroups analyzed here, fetal weight was higher in male newborns. Conclusions: Male sex is an independent risk factor for unfavorable outcomes of pregnancy and delivery.

It is estimated that six million perinatal deaths occur every year worldwide, with premature birth being the main cause. Scientific evidence has shown that there is an association between periodontal health during pregnancy and adverse outcomes of labor, although interventional studies based on the treatment of periodontitis have failed to document an impact on reducing the incidence of preterm birth (PB) or low birth weight (LBW). Two pathogenic mechanisms have been proposed to explain this association. The direct pathway is based on the presence of gram-negative anaerobic bacteremia originating in the gingival biofilm, whereas the indirect pathway involves the production of pro-inflammatory markers which enter the bloodstream from the gingival submucosa. The result is the same: the development of an immune inflammatory response and/or the local suppression of growth factors in the fetal-placental unit, which in turn triggers labor. In the present review, we describe current concepts pertinent to PB and LBW, chronic and aggressive periodontitis, and the most frequent aspects of periodontal pathology during pregnancy. We evaluate the scientific evidence available to date, and offer a detailed description of the two pathways proposed to explain the association of maternal periodontitis with preterm and LBW delivery.

: The aim of this study was to evaluate the effectiveness of the Bakri balloon in treating postpartum hemorrhage refractory to medical treatment. This retrospective study included 24 women with postpartum hemorrhage treated with a Bakri balloon as a conservative therapeutic option. The Bakri balloon was successful in controlling hemorrhage in 87.5% of the women. It was effective in all women with vaginal delivery (five of five) and in all women with uterine atony who did not respond to medical uterotonic treatment (eight of eight). Its ease of use and high effectiveness make the Bakri balloon a useful approach for the conservative management of acute postpartum hemorrhage. This device reduces bleeding, shortens the hospital stay and avoids the need for more aggressive procedures.

Around two percent of asymptomatic women in labor test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Spain. Families and care providers face childbirth with uncertainty. We determined if SARS-CoV-2 infection at delivery among asymptomatic mothers had different obstetric outcomes compared to negative patients. This was a multicenter prospective study based on universal antenatal screening for SARS-CoV-2 infection. A total of 42 hospitals tested women admitted for delivery using polymerase chain reaction, from March to May 2020. We included positive mothers and a sample of negative mothers asymptomatic throughout the antenatal period, with 6-week postpartum follow-up. Association between SARS-CoV-2 and obstetric outcomes was evaluated by multivariate logistic regression analyses. In total, 174 asymptomatic SARS-CoV-2 positive pregnancies were compared with 430 asymptomatic negative pregnancies. No differences were observed between both groups in key maternal and neonatal outcomes at delivery and follow-up, with the exception of prelabor rupture of membranes at term (adjusted odds ratio 1.88, 95% confidence interval 1.13–3.11; p = 0.015). Asymptomatic SARS-CoV-2 positive mothers have higher odds of prelabor rupture of membranes at term, without an increase in perinatal complications, compared to negative mothers. Pregnant women testing positive for SARS-CoV-2 at admission for delivery should be reassured by their healthcare workers in the absence of symptoms.

Background: Cesarean delivery (CD) is the most frequently performed surgical procedure worldwide. Trial of labor after cesarean (TOLAC) is associated with an increase in perinatal complications related to uterine rupture. However, in general, vaginal birth after cesarean (VBAC) is considered safe and women have less morbidity than those who undergo an elective repeat CD. Objective: To develop an integrated model with the best performance criteria for predicting vaginal delivery success after CD. Study design: Retrospective observational study including 2367 women who underwent a TOLAC. A predictive model using classification and regression tree modeling was constructed to predict vaginal delivery using maternal demographic, medical history, and labor predictors. Results: Vaginal delivery was best predicted by spontaneous onset of labor, estimated fetal weight <3775 g, maternal body mass index <25, previous CD as an elective or for fetal distress reasons, and interdelivery interval <2290 days. The algorithm showed a sensitivity of 75%, a specificity of 53%, and the area under the curve was 0.69. Conclusions: The classification and regression tree algorithm can be used to develop a predictive model for the success of TOLAC.