Increased maternal age and body mass index together with NYHA class III-IV, significant pulmonary hypertension, reduced ejection fraction and development of heart failure during pregnancy are strong predictors of poor maternal and fetal outcome.

Some mediators of angiogenesis, such as SDF-1 and endothelial cells, are disturbed in women with idiopathic HMB.

<b><i>Objective:</i></b> The aim of the present study was to evaluate the effect of autologous platelet-rich plasma (PRP) on wound healing and pain perception after cesarean section in high-risk patients. <b><i>Design:</i></b> This was a prospective randomized controlled trial. <b><i>Participants/Materials, Settings, and Methods:</i></b> This was a randomized controlled trial of 200 patients who came to the outpatient clinic of Menoufia University Hospital for elective cesarean surgery. The women were randomly assigned to 2 equal groups. The intervention group received PRP subcutaneous injection in the wound after surgery; however, the control group received the usual care. Outcome variables included the redness, edema, ecchymosis, discharge, approximation (REEDA) scale, Vancouver scar scale (VSS), and in addition to the visual analog scale (VAS). <b><i>Results:</i></b> From April 2018 to July 2020, the PRP group showed a greater reduction in the REEDA score compared to the control group on day 1, day 7, and this was continued till 6 months (1.51 ± 0.90 vs. 2.49 ± 1.12, <i>p</i> &#x3c; 0.001). Compared with the control group, the PRP group had a significantly greater reduction in the VSS and VAS scores beginning on the seventh day (3.71 ± 0.99 vs. 4.67 ± 1.25, <i>p</i> &#x3c; 0.001) and (5.06 ± 1.10 vs. 6.02 ± 1.15, <i>p</i> &#x3c; 0.001), respectively, and continued till 6 months. <b><i>Limitations:</i></b> Pain was not measured by the use of analgesics, and we did not investigate the effects of varying platelet concentrations, centrifuge duration, or speed. <b><i>Conclusions:</i></b> PRP has positive effects on wound healing and pain reduction in high-risk patients undergoing cesarean section in low-resource settings.

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Objective: To assess prospectively the maternal and fetal outcome among pregnant women with chronic kidney disease (CKD) compared to normal control group to find out predictors of poor obstetric outcome. Methods: A prospective observational study conducted on 490 pregnant women with CKD who were divided into two groups according to K-DOQI guidelines, group 1 (n=286, stage-1 CKD) and group 2 (n=204, stages 2-4 CKD) with a third group of normal pregnant women (n=200). Obstetric outcome was recorded. Univariate and multivariate regression analysis was used to assess the association between poor obstetric outcome and maternal risk factors. Results: Patients with CKD were more prone to experience poor maternal and fetal outcome compared to control group (p<0.001). Stage of CKD ≥ 2 (OR=2.33, CI= 1.26-3.96), duration of CKD ≥ 5 years (OR=0.69, CI=0.53-0.98), baseline creatinine 1.5-3 mg/dl (OR=2.14, CI=1.34-3.44), baseline creatinine >3 Mg/dL (OR=2.28, CI=1.17-4.05), pelvicalyceal dilatation on renal ultrasound (OR=1.49, CI=1.22-2.85), initial Hypertension (OR=4.11, CI=1.71-9.85), intake of more than two antihypertensive drugs (OR=1.75, CI=1.28-3.88), antenatal care visits<6 (OR=1.99, CI=1.45-2.76), initial proteinuria (OR= 2.23, CI=1.99-2.89), development of preeclampsia (OR=1.66, CI=1.11-3.21), the presence of prenatal anemia (OR=0.14, CI=0.02-0.25) and the presence of underlying systemic disease (OR=3.08, CI=2.04-4.65) were strong predictors of poor obstetric outcome in patients with CKD. Conclusions: Patients with CKD even those in the early stage suffered from poor maternal and fetal outcome. Many risk factors other than hypertension, proteinuria and underlying systemic disease were identified as predictors of poor obstetric outcome.