were more frequent than in the group without HDP conditions. Babies of the preeclamptic and eclamptic mothers were more likely to be stillborn, have low birth weight, low Apgar scores, and neonatal complications. Chronic hypertension was associated with preeclampsia [adjusted odds ratio (OR), 8.32; 95% confidence interval (CI), 7.13-9.72] as was eclampsia (adjusted OR, 12.06; 95% CI,). Preeclampsia and eclampsia were also significantly associated with renal and hepatic disease, anemia, systemic infections or sepsis, nulliparity, multiple pregnancies, and lack of formal education. Maternal age older than 35 years was associated with preeclampsia, whereas age less than 19 years was associated with eclampsia. Of 262 women with preeclampsia who suffered a maternal near-miss, 115 (43.9%) were attributed to coagulation dysfunction, followed by respiratory and cardiovascular dysfunction (24.8% and 24.0%, respectively). For the 126 eclamptic women, most near-misses were related to neurological dysfunction (n = 66; 52.4%). The risk of death was about 4 times higher for women with preeclampsia compared with women without the condition. For women with eclampsia, the risk increased exponentially (adjusted OR, 42.38; 95% CI, 25.14-7.144). The risk of maternal near-miss was 8 and 60 times higher in women with preeclampsia and eclampsia, respectively. The risks of fetal and neonatal death, preterm birth, and admission to an NICU were increased in both conditions with the risk slightly higher in eclampsia.The data reported in this study contribute useful information to researchers studying global maternal morbidity. They could also be used to guide practice and policy recommendations regarding the most frequent complications and related to HDP.

(Am J Obstet Gynecol 2016;214(1):6–14) Obstetric providers are challenged continuously with the evaluation of the potential benefits and harms of new diagnostic and therapeutic procedures or treatments for patients (mother and fetus), often in the setting of limited high-quality data (eg, from randomized clinical trials). Between 800,000 and 1.4 million people in the United States and >240 million people worldwide are infected with hepatitis B virus (HBV). Specific to pregnancy, an estimated prevalence of 0.7% to 0.9% for chronic hepatitis B infection among pregnant women in the United States has been reported, with >25,000 infants at risk for infection born annually to these women. The purpose of this document is to aid clinicians in counseling their patients regarding the risk and management options available after receiving a positive hepatitis B surface antigen (HBsAg) test result.

Objective-To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations.Methods-This was a secondary analysis of NICHD Assessment of Perinatal Excellence (APEX) cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008-2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10 cm cervical dilation were included. Women in whom pushing was delayed by ≥60 minutes (delayed group) were compared with those who initiated pushing within 30 minutes (early group). Multivariable regression analyses were used to assess the independent association of delayed pushing with mode of delivery, length of second stage and other maternal and perinatal outcomes (significance defined as p<0.05).Results-Of 21,034 women in the primary analysis sample, pushing was delayed in 18.4% (n=3870). Women who were older, privately insured, or non-Hispanic white, as well as those who Conclusion-In this large birth cohort, delayed pushing was associated with longer second stage duration, increased odds of cesarean delivery, and increased odds of postpartum hemorrhage, but was not associated with neonatal morbidity. HHS Public Access

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