The association between polyunsaturated fatty acid (PUFA) supplementation, particularly omega-3 and omega-6 fatty acids, during the third trimester of pregnancy and obstetric outcomes is not well established. This prospective birth cohort study included 12,050 women who delivered at Kuopio University Hospital (KUH) between 2013 and 2024, and completed a questionnaire about supplementation after 28 weeks of gestation. Data were obtained from the KUH Birth Register and the questionnaire. The primary outcomes were maternal blood loss and the incidence of postpartum haemorrhage (PPH), while secondary outcomes included pregnancy complications and neonatal well-being. Approximately 10 % of women reported daily PUFA supplementation during the third trimester. Regular daily use was associated with significantly greater blood loss in vaginal deliveries, although the increase was modest. A trend towards increased PPH was observed among PUFA users, whereas no similar association was found among women undergoing caesarean delivery. PUFA users tended to have a lower prevalence of pre-eclampsia, and their newborns had fewer low Apgar scores at 1 and 5 min, whereas no significant differences in umbilical artery pH or base excess values were observed between PUFA users and non-users. Discontinuing PUFA supplementation approximately 1 month before the expected date of delivery or elective caesarean delivery may be reasonable. However, the potential beneficial effects of PUFA supplementation on the development of pre-eclampsia warrant further investigation in future studies.

Background and Objectives: To evaluate maternal characteristics associated with placenta previa in comparison with breech cesarean controls, as well as maternal and neonatal outcomes. Materials and Methods: A retrospective case-control study was conducted at the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics (2015-2022). A total of 150 cases of placenta previa were compared with a control group of participants who underwent cesarean delivery due to fetal breech presentation without placenta previa. Results: In multivariable analysis, higher parity, prior cesarean delivery, in vitro fertilization, prior surgical termination of pregnancy, and prior uterine surgery were independently associated with placenta previa compared with breech cesarean controls. Maternal complications were significantly more frequent in the placenta previa group and included placenta accreta spectrum disorders, second- and third-trimester hemorrhage, postpartum hemorrhage, and increased need for blood transfusion. The most severe outcomes, including cesarean hysterectomy, occurred exclusively in cases complicated by placenta accreta spectrum disorders. Neonatal outcomes in the placenta previa group were characterized by higher rates of preterm birth, low Apgar scores, and birth weight < 2500 g. Adverse neonatal outcomes were partly associated with earlier gestational age at delivery. However, placenta previa remained associated with low Apgar score after adjustment. Conclusions: Compared with breech cesarean controls, placenta previa was associated with multiple maternal characteristics, including higher parity, prior cesarean delivery, in vitro fertilization, prior surgical termination of pregnancy, and prior uterine surgery. The condition is linked to increased maternal hemorrhagic morbidity, particularly in cases complicated by placenta accreta spectrum disorders, as well as adverse neonatal outcomes mainly related to prematurity. These findings highlight the importance of careful antenatal monitoring and delivery planning in specialized centers.

Uterine rupture following myomectomy represents a rare but severe complication of pregnancy, with a reported incidence of less than 1%. It most commonly occurs during the late second or third trimester and is associated with significant maternal hemorrhage and fetal compromise. We report the case of a 36-year-old G3P0 woman at 28 + 5 weeks of gestation with a history of prior laparoscopic myomectomy complicated by postoperative hemorrhage and sepsis, who presented with acute abdominal pain and hemodynamic instability. Emergency laparotomy revealed approximately 1000 mL hemoperitoneum and a 3 cm rupture of the posterior wall of the lower uterine segment. A live preterm neonate was delivered via cesarean section, followed by total hysterectomy due to extensive uterine pathology and ongoing hemorrhage. The postoperative course was uneventful, and the neonate required intensive care support. This case underscores the importance of maintaining a high index of suspicion for uterine rupture in pregnant patients with a history of uterine surgery and highlights the potential role of surgical technique and uterine wall reconstruction in determining subsequent scar integrity.

Background: Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is rare, occurring in approximately 0.01-0.05% of pregnancies, most commonly in the third trimester. Its management is particularly challenging, requiring careful consideration of both maternal and fetal outcomes. Methods: We report the case of a 32-year-old woman at 31 weeks of gestation who presented with severe headache and left third cranial nerve palsy. Imaging revealed diffuse SAH with significant obstructive hydrocephalus and a 5 mm left posterior communicating artery aneurysm. Following multidisciplinary discussion, surgical clipping was performed while preserving the pregnancy to allow for fetal lung maturation. On postoperative day 8, the patient developed right-sided weakness and aphasia secondary to severe vasospasm. Initial management with catecholamine-induced hypertension resulted in increased uterine contractions and fetal distress. Subsequent intra-arterial administration of nimodipine effectively resolved the vasospasm, enabling cessation of vasopressor therapy. After achieving fetal lung maturity, cesarean section was performed at 34 weeks, followed by ventriculo-peritoneal shunt placement for communicating hydrocephalus. Due to sustained shunt failure, the distal catheter was finally inserted into the superior vena cava at the junction of the atrium. Results: The patient showed gradual neurological recovery with complete resolution of third cranial nerve palsy, and both mother and infant were discharged without complications. Conclusions: This case highlights that while standard vasospasm therapies can be implemented during pregnancy, hemodynamic approaches may provoke maternal and fetal complications. Endovascular rescue strategies should be promptly considered for severe vasospasm, and ventriculo-atrial shunting for complex communicating hydrocephalus may serve as a viable alternative option in post-cesarean patients.

Mid-trimester termination of pregnancy in individuals with a previous Caesarean section (CS) presents a heightened clinical challenge due to the risk of uterine scar complications, including rupture and hemorrhage. The combined regimen of mifepristone and misoprostol is a well-established method for medical termination; however, its safety and efficacy profile in patients with a uterine scar, particularly during the mid-trimester, remains a significant area of clinical concern and requires further evidence-based evaluation. The study was aimed to find out the outcome of mid trimester termination of pregnancy in previous caesarian section by combined mifepristone and misoprostol. This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Bangladesh from July 2021 to June 2022. A total of 196 patients were enrolled in this study as per selection criteria. All relevant data were collected in a data collection form (questionnaire). Data were processed and analyzed with the help of computer program SPSS windows version 23.0. Conclusion will be set on the basis of findings. The maximum patients (46.4%) were in the age group of 25 to 29 years. Mean age of the study subjects was 26.13±3.63 years ranged from 20-35 years. Most of the patients were housewife (91.8%). Most of the cases parity was single (57.7%) followed by 2 in 22.4% cases and >2 in 19.9% cases. Most women were in their second pregnancy (63.3%), while 30.6% were in their third pregnancy. Complete expulsion was occurred in 86.7% cases, incomplete in 10.2% cases and no expulsion in 3.1% cases. Mean number of doses of misoprostol for successful expulsion was 4.12±0.90 ranged from 1 to 5 doses. Mean time interval between 1st dose and spontaneous expulsion 9.39±2.74 hours ranged from 3 to 12 hours. Complications following mid trimester termination of pregnancy were severe hemorrhage (28.1%), retained placenta (17.9%), severe pain (14.3%) and scar rupture (4.6%). No complication was observed in 55.5 cases. Mid-trimester medical termianl of pregnancy with mifepristone-misoprostol is a safe and effective procedure for the patients with previous caesarian section.

PURPOSE: The aim of this study was to investigate the hypothesis that pregnant women diagnosed with bacterial vaginosis (BV) may encounter more adverse outcomes during induced labour. METHODS: The study population consisted of 474 pregnant women who were categorized into two groups based on the findings of a vaginal discharge test: BV group and the nonvaginitis group. The BV group consisted of both the BV group and the BV+ vulvovaginal candidiasis(VVC) group. Based on the Bishop score, labour induction was performed utilizing diverse techniques, such as the insertion of a dinoprostone plug, and amniotomy in conjunction with oxytocin. The statistical analysis of the experimental data was conducted using SPSS software. RESULTS: Compared to the nonvaginitis group, the BV group exhibited a higher incidence of caesarean section and a lower incidence of vaginal delivery (24.24% vs. 11.99%; 75.76% vs. 88.01%; P = 0.001). Additionally, the BV group experienced a greater occurrence of adverse maternal and infant outcomes, including increased postpartum bleeding, postpartum haemorrhage, blood transfusion, chorioamnionitis, postpartum urinary retention, puerperal infection, meconium-stained amniotic fluid, neonatal infection, and admission to the neonatal intensive care unit (p<0.05). In comparison to the single BV group, the BV + VVC group exhibited elevated levels of postpartum bleeding, postpartum haemorrhage (PPH), blood transfusion, chorioamnionitis, meconium-stained amniotic fluid, neonatal infection (n,%) and admission to the neonatal intensive care unit (n,%) (p<0.05). After controlling for age, BMI, Bishop score, history of vaginitis during pregnancy, mode of induction and birth weight, statistically significant differences in adverse maternal and child outcomes between BV and nonvaginitis groups persisted. CONCLUSION: BV during the third trimester of pregnancy has been correlated with a significant increase in the incidence of caesarean section following labour induction in primiparous women, as well as adverse outcomes for both mothers and infants. It is imperative for clinicians to allocate greater attention towards the assessment of BV during the third trimester of pregnancy.