Background: Inflammatory bowel disease (IBD) can have an impact on pregnancy outcomes due to the effect of the disease activity and medication use. This study aimed to evaluate the pregnancy outcomes in IBD patients treated at a multidisciplinary clinic. Methods: This study was a retrospective cohort study including consecutive pregnant patients with IBD having a singleton gestation attending a multidisciplinary clinic between 2012 and 2019. The IBD activity and management throughout gestation were assessed. The pregnancy outcomes included: adverse neonatal and maternal outcomes, mode of delivery, and three integrative outcomes: (1) a favorable pregnancy outcome, (2) a poor pregnancy outcome, and (3) an unfavorable maternal outcome. The IBD pregnant cohort was compared with a cohort of non-IBD pregnant women delivering at the same shift. Multivariable logistic regression was used for risk assessment. Results: Pregnant women with IBD (141) and without (1119) were included. Mean maternal age was 32 [±4] years. Patients with IBD had a higher rate of nulliparity (70/141 (50%) vs. 340/1119 (30%), p < 0.001) and lower BMI (21.42 kg/m² (19.18–23.44) vs. 22.48 (20.31–25.59), p = 0.002). All the other characteristics were comparable. Most patients with IBD 124/141 (88%) were in clinical remission at conception; with maintenance therapy in 117/141 patients (83%). A third of the patients, 43/141 (30.5%), were treated with biologics. Exacerbation occurred during pregnancy in 51/141 (36%). The majority of the maternal and neonatal outcomes and all the composite outcomes were comparable between the patients with IBD and the women without IBD. Cesarean delivery was more frequent in patients with IBD (49/141 (34.8%) vs. 270/1119 (24.1%), p = 0.021). IBD was not associated with composite outcomes. Conclusions: In pregnant patients with IBD followed at a multidisciplinary clinic, the pregnancy outcomes were encouraging and comparable to those of the women without IBD.

Objective: Maternal thrombocytopenia during pregnancy may occur due to several possible etiologies, with potential neonatal impact. The aim of the present study was to investigate whether there is a correlation between maternal and neonatal platelet count among women with thrombocytopenia during pregnancy.Methods: A cross‐sectional retrospective study (2012–2019) was conducted at a tertiary medical center. Complete blood count was routinely measured in all patients on admission to the delivery ward. Thrombocytopenia was defined as a platelet count below 150 K/μL. Clinical and outcome parameters of thrombocytopenic mothers and their newborns were collected from the electronic files and analyzed by severity of maternal thrombocytopenia.Results: Of 45 385 women with a documented platelet count at admission, 2841 (6.24%) had thrombocytopenia: 2623 (5.7%) mild (100–149 K/μL), 207 (0.45%) moderate (50–99 K/μL), and 11 (0.02%) severe (<50 K/μL). Eight newborns had thrombocytopenia; corresponding rates by severity of maternal thrombocytopenia were 0.11%, 1.43%, and 18.18% (P = 0.04). None of the thrombocytopenic neonates had an intraventricular hemorrhage or other bleeding complications. The correlation between maternal and neonatal platelet counts was weak (Pearson r = 0.038; P = 0.046).Conclusion: We suggest that although the chances of neonatal thrombocytopenia are higher with worsening maternal thrombocytopenia, actual occurrence is rare, and the correlation is poor. Therefore, maternal thrombocytopenia cannot be regarded as a significant risk factor for neonatal thrombocytopenia. Neonatal platelet count should be obtained when maternal thrombocytopenia is autoimmune or less than 100 K/μL.

Objective: True umbilical cord knot (TUCK) is a rare finding that often leads to intensified surveillance and patient anxiety. This study sought to evaluate the incidence, risk factors, and obstetric and neonatal outcomes of TUCK.Methods: A retrospective cohort study was conducted at a tertiary university medical center in 2007–2019. Patients with singleton pregnancies diagnosed postnatally with TUCK were identified and compared to women without TUCK for obstetric and neonatal outcomes using propensity score matching (PSM).Results: TUCK was diagnosed in 780 of the 96,766 deliveries (0.8%). Women with TUCK were older than those without TUCK (32.57 vs. 31.06 years,P < 0.001) and had higher gravidity (3 vs. 2,P < 001) and a higher rate of prior stillbirth (1.76% vs. 0.43%,P < 0.01). Following covariate adjustment, 732 women with TUCK were compared to 7320 matched controls. TUCK was associated with emergency cesarean delivery due to non-reassuring fetal heart rate (2.54% vs. 4.35%,P = 0.008, OR 1.71, 95%CI 1.14–2.56) and intrapartum meconium-stained amniotic fluid (19.26% vs. 15.41%,P = 0.022, OR 1.31, 95%CI 1.04–1.65). Neonatal outcomes were comparable except for higher rates of 1-min Apgar score < 7 and neonatal seizures in the TUCK group. The stillbirth rate was higher in the TUCK group, but the difference was not statistically significant (1.23% vs 0.62%,P = 0.06, OR 1.96, 95%CI 0.96–4.03).Conclusions: TUCK has several identifiable risk factors. Pregnant women with TUCK may cautiously be informed of the relatively low risks of major obstetric or perinatal complications. The lower occurrence of stillbirth in the TUCK group warrants further study.

Background: Pregnant women with a previous cesarean delivery (CD) may opt for a trial of labor after cesarean (TOLAC) or elective repeat cesarean delivery (ERCD). This study aimed to evaluate the success rate, and maternal, and perinatal outcomes of TOLAC and to develop a predictive decision‐tree algorithm for successful TOLAC. Methods: A retrospective study was conducted in a tertiary medical center and included all women with one prior CD who delivered between 2008 and 2019. Maternal and perinatal outcomes were compared between successful and failed TOLAC and ERCD groups. A decision‐tree algorithm was constructed using the χ ² automatic interaction detection method. Results: Of 10 325 women with one prior CD (out of 103 542 deliveries), the rate of successful TOLAC, defined as vaginal birth after cesarean (VBAC), was 81.92%. Symptomatic uterine rupture occurred in 55 women (0.98%), with no cases of hysterectomy, or maternal or neonatal death. The decision tree identified key predictors of VBAC success, including maternal age, gestational age at delivery, and history of vaginal delivery. Women with a prior vaginal delivery had the highest likelihood of VBAC (90.3%). The overall accuracy of the model was 82.7%. Conclusions: This study demonstrated a high rate of TOLAC attempts and VBAC success in a tertiary medical center with experienced staff and close monitoring. Uterine rupture was rare and not associated with severe maternal or neonatal morbidity or mortality. The decision‐tree algorithm provides a practical tool to predict successful TOLAC, supporting individualized care and informed decision making.