Objective To identify predictors of the success of manual rotation of fetuses in an occiput posterior position. Methods A prospective, observational, single‐center study included all women with a singleton pregnancy at term with a fetus in an occiput posterior position for whom manual rotation was attempted from December 1, 2013, to April 30, 2015 at a tertiary care maternity unit in Nancy, France. Occiput posterior position was confirmed by ultrasonography, and success of manual rotation was defined by the occiput anterior position of the fetus after the attempt. Results Occiput posterior position was diagnosed in 233 (9.2%) of the 2522 deliveries during the study period and the majority of cases were managed successfully by manual rotation (167 [71.7%]). Factors associated with successful rotation were fetal engagement (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.05–4.56), spontaneous labor (aOR 1.85, 95% CI 1.01–3.43), and no failure to progress (aOR 2.01, 95% CI 1.02–3.94). Successful manual rotation was associated with lower rates of cesarean (P<0.001) and instrumental (P<0.001) deliveries. Conclusion Study findings suggested that manual rotation, especially after fetal engagement, succeeded more often when performed systematically than when it was attempted after failure to progress.

We report the case of a severe COVID-19 infection in which the diagnosis of preeclampsia (PE) was wrongly assumed because of proteinuria. This case raises both the question of the predictive value of proteinuria and the differential diagnosis between preeclampsia and the severe form of COVID-19 in pregnant women. Despite numerous publications related to the pandemic, data remain limited regarding COVID-19 infections in pregnant women. The reported rates of severe infections range between 14 % (severe pneumonia) to 5% (severe acute respiratory syndrome/SARS) [1]. There are no clear maternal risk factors predicting severe infection in pregnant woman. A 26-year old woman (gravida 4, para 2) was admitted at 37 weeks of gestation with a 24-hs history of dry cough and headache. One of her relatives was infected by Covid-19. Until then the pregnancy was uneventful. At the time of hospital admission to the Covid-19 unit, her temperature was 37.9 C, her cardiac heart rate 112 beats per minute, her blood pressure 148/83 mm/Hg, her respiratory rate 22 breaths per minute and her oxygen saturation 98 % (ambient air breathing). Fetal heart rate was normal. Covid-19 nasopharyngeal tests were positive. On day 2, the 24-h urine protein test (performed due to arterial pressure >140/90 mmHg) was positive (1,2 g/24 h) and a suspected PE diagnosis was verified accordingly. On day 3 labour was induced on this indication in accordance with our national guidelines [2]. A C-section was performed because of arrested labor. A healthy 2700 g baby boy was born, with negative Covid-19 nasopharyngeal tests. In the post-partum period, the patient developed a respiratory distress syndrome requiring her transfer to the Intensive Care Unit (ICU) on day 5. From day 7 to day 17, she needed invasive ventilation and extracorporeal membrane oxygenation. She fully recovered on day 22. This case describes a complicated post-partum period in a woman with Covid-19. We suspected preeclampsia in this patient, which is a common disorder in pregnancy with hypertension and proteinuria related to placental dysfunction [2]. In their recent publication, Liu et al. highlighted the fact that proteinuria is more pronounced in non-pregnant Covid-19 patients than in healthy controls (28.57 % Vs 11.11 %; p < 0.05) [3]. Proteinuria seems to be associated with Covid-19 severity [3]. Di Mascio et al. observed a 16.2 % rate of preeclampsia in pregnancies affected by Coronavirus [4]. This is much more common than the 2-8 % rate in the general population [2]. The first hypothesis that might be put forward is that of false positive diagnosis of PE, with the proteinuria in fact being linked to infection itself (as suggested by Mendoza et al. [5]). The second hypothesis that

Bladder exstrophy is a congenital urogenital anomaly and improved health care for children with bladder exstrophy can facilitate pregnancy during adult life.The present retrospective study included female patients who had bladder exstrophy diagnosed at birth and who presented with a pregnancy at two hospitals (university hospitals in Nancy and Strasbourg) between January 1, 2000, and December 31, 2016; there were no exclusion criteria applied. Patients were identified from hospital databases. Owing to the study design, consent and formal ethical approval were not required.Medical record data were included from six pregnancies among three patients. Patient demographic data, previous surgeries, urinary continence before and after pregnancy, the number of spontaneous abortions, any need for assisted fertilization, evolution of pregnancy, mode of delivery, neonatal data, and postpartum adverse events were recorded.All of the patients had spontaneous pregnancies and no spontaneous abortions were recorded (Table 1). However, abdominopelvic surgeries can result in postoperative adhesions, potentially making patients susceptible to increased infertility. Pyelonephritis was recorded in 2 (33%) pregnancies, compared with an incidence of 0.5% in the general population. 1 Pyelonephritis can cause preterm labor, and this occurred during one pregnancy in the present study.The prophylactic prescription of antibiotics during pregnancy has previously been suggested for patients with a history of bladder exstrophy. 2 Cesarean deliveries were performed for all pregnancies included, with planned cesarean deliveries performed in five of the pregnancies; this was preferred for neonatal health and to protect bladder reconstruction. It is suggested that emergency situations should be averted to prevent cystoplasty injury and potential fetal distress.Among the six pregnancies, 3 (50%) breech presentations were recorded, in comparison with an incidence of 3% in the general population. 3 Fetal malposition is a phenomenon due to uterine malformation and pelvis anomalies, as described by Dy et al. 4 Based on the results of the present study, it is suggested that women with bladder exstrophy can have a healthy reproductive life. In a study in Germany, 5 stable relationships and being sexually activity were reported by 73% and 90% of women born with bladder exstrophy, respectively.At the study institution, follow-up for these pregnancies was similar to other pregnancies. However, at the beginning of these pregnancies, each patient had a medical consultation with an urologist to help prevent potential adverse events. A history of bladder exstrophy should not be a contraindication to pregnancy but it is suggested that it is essential to consider an interdisciplinary approach and that the most important adverse event risk is urinary tract infection. Based on the guidelines proposed by Dy et al., 4 close monitoring of serum creatinine, renal function, ultrasonography, and urine culture is necessary.Cesarean delivery should be planned and a surg...

The success of labor induction and consecutive vaginal delivery were high in case of moderate and late preterm birth. Labor induction can be considered as an effective option for medical indications.

Key Clinical MessageApert syndrome in monozygotic twins can lead to different phenotypic expression of the disease in the two fetuses. Apert syndrome can be associated with congenital left diaphragmatic hernia and cleft palate.

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